Provider Demographics
NPI:1144304759
Name:LALEZARZADEH, FARHAD (DDS)
Entity type:Individual
Prefix:MR
First Name:FARHAD
Middle Name:
Last Name:LALEZARZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1042
Mailing Address - Country:US
Mailing Address - Phone:323-923-3710
Mailing Address - Fax:323-923-3709
Practice Address - Street 1:3559 E. GAGE AVE.
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201
Practice Address - Country:US
Practice Address - Phone:323-923-3710
Practice Address - Fax:323-923-3709
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9360401Medicaid