Healthcare Provider Details

I. General information

NPI: 1356865422
Provider Name (Legal Business Name): F.FARSHIDI DDS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17452 IRVINE BLVD STE 100
TUSTIN CA
92780-3031
US

IV. Provider business mailing address

17452 IRVINE BLVD STE 100
TUSTIN CA
92780-3031
US

V. Phone/Fax

Practice location:
  • Phone: 714-838-4141
  • Fax:
Mailing address:
  • Phone: 714-838-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS63573
License Number StateCA

VIII. Authorized Official

Name: DR. FARZIN FARSHIDI
Title or Position: PRESIDENT
Credential: DDS MD
Phone: 714-838-4141