Healthcare Provider Details

I. General information

NPI: 1275946501
Provider Name (Legal Business Name): FARHAD DENA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 ENCINTAS BLVD., SUITE D
ENCINITAS CA
92024
US

IV. Provider business mailing address

1403 ENCINTAS BLVD., SUITE D
ENCINITAS CA
92024
US

V. Phone/Fax

Practice location:
  • Phone: 760-943-7788
  • Fax: 760-943-9988
Mailing address:
  • Phone: 760-943-7788
  • Fax: 760-943-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: