Provider Demographics
NPI:1023108735
Name:ZAGHI, FARSHAD A (DMD, MSD)
Entity type:Individual
Prefix:
First Name:FARSHAD
Middle Name:A
Last Name:ZAGHI
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 VIA LATA
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3918
Mailing Address - Country:US
Mailing Address - Phone:909-340-9100
Mailing Address - Fax:855-379-2444
Practice Address - Street 1:944 VIA LATA
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3918
Practice Address - Country:US
Practice Address - Phone:909-340-9100
Practice Address - Fax:855-379-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-2001223X0400X
CA413311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics