Healthcare Provider Details

I. General information

NPI: 1174613236
Provider Name (Legal Business Name): FARSHID MEHRABAN VAHED DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 INDIANA AVE
RIVERSIDE CA
92503-5412
US

IV. Provider business mailing address

3857 BIRCH ST SUITE 220
NEWPORT BEACH CA
92660-2616
US

V. Phone/Fax

Practice location:
  • Phone: 951-689-0701
  • Fax:
Mailing address:
  • Phone: 949-721-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: