Provider Demographics
NPI:1912249392
Name:SHAHZADI, FARHANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARHANG
Middle Name:
Last Name:SHAHZADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:
Other - Last Name:SHAHZADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:24541 PACIFIC PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3065
Mailing Address - Country:US
Mailing Address - Phone:949-292-2733
Mailing Address - Fax:949-643-7049
Practice Address - Street 1:24541 PACIFIC PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3065
Practice Address - Country:US
Practice Address - Phone:949-292-2733
Practice Address - Fax:949-643-7049
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474171223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice