Provider Demographics
NPI:1750700134
Name:FARWEST DENTAL GROUP
Entity type:Organization
Organization Name:FARWEST DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKWADRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-835-5130
Mailing Address - Street 1:8880 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-3635
Mailing Address - Country:US
Mailing Address - Phone:323-758-6768
Mailing Address - Fax:
Practice Address - Street 1:8880 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3635
Practice Address - Country:US
Practice Address - Phone:323-758-6768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50718261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental