Provider Demographics
NPI:1942737234
Name:FARA SHAHANI, DMD, INC.
Entity Type:Organization
Organization Name:FARA SHAHANI, DMD, INC.
Other - Org Name:GOLDEN STATE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARANAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-494-1900
Mailing Address - Street 1:3515 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3515 ALMA ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3539
Practice Address - Country:US
Practice Address - Phone:650-494-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610611223G0001X
CA124Q00000X
CA13410261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty