MEDICARE: DR. FARZIN MEHRDAD D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	47127	CA

General Provider Information

NPI Number	:	1427251560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARZIN MEHRDAD D.D.S

Provider Business Mailing Address
First Line	:	1175 BAKER ST
Second Line	:	SUITE# A-4
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4101
Country	:	US
Telephone Number	:	714-545-9990
Fax Number	:	714-545-7108

Provider Business Practice Location Address
First Line	:	1175 BAKER ST
Second Line	:	SUITE# A-4
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4101
Country	:	US
Telephone Number	:	714-545-9990
Fax Number	:	714-545-7108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	08/05/2009

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