Healthcare Provider Details

I. General information

NPI: 1144304759
Provider Name (Legal Business Name): FARHAD LALEZARZADEH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3559 E. GAGE AVE.
BELL CA
90201
US

IV. Provider business mailing address

3559 GAGE AVE
BELL CA
90201-1042
US

V. Phone/Fax

Practice location:
  • Phone: 323-923-3710
  • Fax: 323-923-3709
Mailing address:
  • Phone: 323-923-3710
  • Fax: 323-923-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: