Healthcare Provider Details

I. General information

NPI: 1386267698
Provider Name (Legal Business Name): FARSIO, AMINI D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 E MACARTHUR CRES STE 109
SANTA ANA CA
92707-5907
US

IV. Provider business mailing address

31 E MACARTHUR CRES STE 109
SANTA ANA CA
92707-5907
US

V. Phone/Fax

Practice location:
  • Phone: 714-549-1248
  • Fax: 714-549-1246
Mailing address:
  • Phone: 714-549-1248
  • Fax: 714-549-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SAMIRA AMINI
Title or Position: OWNER
Credential: DDS
Phone: 714-549-1248