Provider Demographics
NPI:1932566676
Name:FARIBA BIGDELI DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FARIBA BIGDELI DDS A PROFESSIONAL CORPORATION
Other - Org Name:LAGUNA DENTAL & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGDELI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-831-2905
Mailing Address - Street 1:27932 LA PAZ RD STE F
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3922
Mailing Address - Country:US
Mailing Address - Phone:949-831-2905
Mailing Address - Fax:
Practice Address - Street 1:27932 LA PAZ RD STE F
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3922
Practice Address - Country:US
Practice Address - Phone:949-831-2905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
CA63565302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952700346OtherPECOS