Provider Demographics
NPI:1295875565
Name:RASTEGAR, FARHOUD (DMD)
Entity type:Individual
Prefix:DR
First Name:FARHOUD
Middle Name:
Last Name:RASTEGAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 FRAZEE RD
Mailing Address - Street 2:209
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4337
Mailing Address - Country:US
Mailing Address - Phone:619-574-6678
Mailing Address - Fax:619-574-6680
Practice Address - Street 1:1450 FRAZEE RD
Practice Address - Street 2:209
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4337
Practice Address - Country:US
Practice Address - Phone:619-574-6678
Practice Address - Fax:619-574-6680
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice