Healthcare Provider Details

I. General information

NPI: 1144636242
Provider Name (Legal Business Name): FARIGHI D D S INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 W 17TH ST
SANTA ANA CA
92706-2323
US

IV. Provider business mailing address

2002 W 17TH ST
SANTA ANA CA
92706-2323
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-6666
  • Fax: 714-543-6601
Mailing address:
  • Phone: 714-543-6666
  • Fax: 714-543-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41076
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number41076
License Number StateCA

VIII. Authorized Official

Name: DR. ALIREZA FARIGHI
Title or Position: DENTIST
Credential: DDS
Phone: 714-543-6666