Provider Demographics
NPI:1629562533
Name:DAR, FAHAD ASHRAF (DMD)
Entity type:Individual
Prefix:
First Name:FAHAD
Middle Name:ASHRAF
Last Name:DAR
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 1:1050 ROMANS RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4727
Mailing Address - Country:US
Mailing Address - Phone:951-905-4264
Mailing Address - Fax:
Practice Address - Street 1:7125 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4466
Practice Address - Country:US
Practice Address - Phone:702-658-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty