Healthcare Provider Details

I. General information

NPI: 1508084799
Provider Name (Legal Business Name): F. MOFTAKHAR DDS A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 E 9TH ST
OAKLAND CA
94601-2938
US

IV. Provider business mailing address

1809 E ECKERMAN AVE
WEST COVINA CA
91791-1112
US

V. Phone/Fax

Practice location:
  • Phone: 510-534-0706
  • Fax: 510-534-1082
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: FARSHAD MOFTAKHAR
Title or Position: OWNER / CEO
Credential: DDS
Phone: 626-246-0150