Provider Demographics
NPI:1952601627
Name:FARIBA, TINA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:S
Last Name:FARIBA
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 1:7155 SHERBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4656
Mailing Address - Country:US
Mailing Address - Phone:858-472-3766
Mailing Address - Fax:
Practice Address - Street 1:3805 CLAIREMONT DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5832
Practice Address - Country:US
Practice Address - Phone:858-278-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist