Provider Demographics
NPI:1952872517
Name:EDWARD FARAJZADEH, DDS APDC
Entity Type:Organization
Organization Name:EDWARD FARAJZADEH, DDS APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAJZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-792-6662
Mailing Address - Street 1:13983 MANGO DR STE 106
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3146
Mailing Address - Country:US
Mailing Address - Phone:858-792-6662
Mailing Address - Fax:
Practice Address - Street 1:13983 MANGO DR STE 106
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3146
Practice Address - Country:US
Practice Address - Phone:858-792-6662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty