Healthcare Provider Details

I. General information

NPI: 1134368228
Provider Name (Legal Business Name): FARSHAD SAGHATCHI DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26534 MOULTON PKWY STE D
LAGUNA HILLS CA
92653-8241
US

IV. Provider business mailing address

26534 MOULTON PKWY STE D
LAGUNA HILLS CA
92653-8241
US

V. Phone/Fax

Practice location:
  • Phone: 949-831-8100
  • Fax: 949-831-8122
Mailing address:
  • Phone: 949-831-8100
  • Fax: 949-831-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45970
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number49877
License Number StateCA

VIII. Authorized Official

Name: DR. FARSHAD SAGHATCHI
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 949-831-8100