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General NPI Number Information
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NPI Number | 1073528865
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Entity Type | Organization
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Legal Business Name | FARA SALEHI DDS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 18740 VENTURA BLVD STE 105
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City | TARZANA
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State | CA
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Zip | 91356
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Country | US
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Telephone | 818-342-2000
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Fax | 818-708-8000
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Provider Business Mailing Address
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Address Line | 18740 VENTURA BLVD STE 105
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City | TARZANA
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State | CA
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Zip | 91356
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Country | US
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Telephone | 818-342-2000
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Fax | 818-708-8000
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Authorized Official
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Title or Position | PRESIDENT & OWNER
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Name | FARA SALEHI
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Credential | DDS
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Telephone | 818-342-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36608
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License Number State | CA
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