Provider Demographics
NPI:1740693738
Name:HAROON, FARAH (DDS)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:HAROON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10855 CHURCH ST APT 1610
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8585
Mailing Address - Country:US
Mailing Address - Phone:562-212-2036
Mailing Address - Fax:
Practice Address - Street 1:250 E 7TH ST STE D
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6603
Practice Address - Country:US
Practice Address - Phone:909-982-4169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012670A122300000X
CA1057551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist