Provider Demographics
NPI:1972654465
Name:FARHOOD, VINCENT W (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:W
Last Name:FARHOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3000 ALAMO DR STE 206
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6352
Mailing Address - Country:US
Mailing Address - Phone:707-451-1311
Mailing Address - Fax:707-451-1325
Practice Address - Street 1:3000 ALAMO DR STE 206
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6352
Practice Address - Country:US
Practice Address - Phone:707-451-1311
Practice Address - Fax:707-451-1325
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery