Provider Demographics
NPI:1962813881
Name:FARD & MASTOUR DENTAL CORP
Entity Type:Organization
Organization Name:FARD & MASTOUR DENTAL CORP
Other - Org Name:ENCINO ESTHETICS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAGH-FARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-990-6653
Mailing Address - Street 1:15720 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2914
Mailing Address - Country:US
Mailing Address - Phone:818-990-6653
Mailing Address - Fax:818-990-5525
Practice Address - Street 1:15720 VENTURA BLVD STE 514
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4722
Practice Address - Country:US
Practice Address - Phone:818-990-6653
Practice Address - Fax:818-990-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48007OtherDENTAL LICENSE
CA47525OtherDENTAL LICENSE