Provider Demographics
NPI:1982964797
Name:SEYEDEIN, FARSHAD
Entity Type:Individual
Prefix:
First Name:FARSHAD
Middle Name:
Last Name:SEYEDEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 PASEO GILBERTO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5705
Mailing Address - Country:US
Mailing Address - Phone:714-767-1353
Mailing Address - Fax:
Practice Address - Street 1:5504 PASEO GILBERTO
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-5705
Practice Address - Country:US
Practice Address - Phone:714-767-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS611761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics