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General NPI Number Information
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NPI Number | 1962813881
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Entity Type | Organization
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Legal Business Name | FARD & MASTOUR DENTAL CORP
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 15720 VENTURA BLVD STE 514
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City | ENCINO
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State | CA
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Zip | 91436-4722
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Country | US
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Telephone | 818-990-6653
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Fax | 818-990-5525
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Provider Business Mailing Address
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Address Line | 15720 VENTURA BLVD
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City | ENCINO
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State | CA
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Zip | 91436-2914
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Country | US
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Telephone | 818-990-6653
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Fax | 818-990-5525
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ARASH SABBAGH-FARD
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Credential | DDS
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Telephone | 818-990-6653
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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 | 48007
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License Number State | CA
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