Provider Demographics
NPI:1912243098
Name:MAHSHID FARHOUMAND DDS INC
Entity Type:Organization
Organization Name:MAHSHID FARHOUMAND DDS INC
Other - Org Name:BRILLIANT SMILE DENTAL GROUP OF MAHSHID FARHOUMAND DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAHSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHOUMAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-716-7166
Mailing Address - Street 1:23024 LAKE FOREST DR
Mailing Address - Street 2:STE A
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1328
Mailing Address - Country:US
Mailing Address - Phone:949-716-7166
Mailing Address - Fax:949-716-9191
Practice Address - Street 1:23024 LAKE FOREST DR
Practice Address - Street 2:STE A
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1328
Practice Address - Country:US
Practice Address - Phone:949-716-7166
Practice Address - Fax:949-716-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty