Provider Demographics
NPI:1942420500
Name:FARNOOSH, ALEXANDER A (DMD, MSD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:A
Last Name:FARNOOSH
Suffix:
Gender:M
Credentials:DMD, MSD, PHD
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:A
Other - Last Name:FARNOOSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MSD, PHD
Mailing Address - Street 1:8920 WILSHIRE BLVD
Mailing Address - Street 2:SUITE #517
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2007
Mailing Address - Country:US
Mailing Address - Phone:310-657-0503
Mailing Address - Fax:310-657-9144
Practice Address - Street 1:8920 WILSHIRE BLVD
Practice Address - Street 2:SUITE #517
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2007
Practice Address - Country:US
Practice Address - Phone:310-657-0503
Practice Address - Fax:310-657-9144
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics