Healthcare Provider Details

I. General information

NPI: 1437423407
Provider Name (Legal Business Name): FARNOOSH ABBASI D.D.S, M.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 CANVAS WAY
MARINA CA
93933-6022
US

IV. Provider business mailing address

2013 CANVAS WAY
MARINA CA
93933-6022
US

V. Phone/Fax

Practice location:
  • Phone: 831-741-6631
  • Fax:
Mailing address:
  • Phone: 831-741-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number61211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: