MEDICARE: FARTASH FARKHONDEHKISH DDS MS

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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1699567222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARTASH FARKHONDEHKISH DDS MS

Provider Business Mailing Address
First Line	:	25283 CABOT RD STE 110
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5509
Country	:	US
Telephone Number	:	949-770-0548
Fax Number	:	949-770-7262

Provider Business Practice Location Address
First Line	:	25283 CABOT RD STE 110
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5509
Country	:	US
Telephone Number	:	949-770-0548
Fax Number	:	949-770-7262

Authorized Official
Title or Position	:	DENTISIT
Name	:	FARTASH FARKHONDEHKISH
Credential	:	DDS,MS
Telephone Number	:	949-770-0548

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/20/2025

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