Provider Demographics
NPI:1730500570
Name:F ESFANDIARI DENTAL CORPORATION
Entity type:Organization
Organization Name:F ESFANDIARI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHID
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:ESFANDIARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-647-6100
Mailing Address - Street 1:9493 TELEPHONE RD
Mailing Address - Street 2:108
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2686
Mailing Address - Country:US
Mailing Address - Phone:805-647-6100
Mailing Address - Fax:805-647-6107
Practice Address - Street 1:9493 TELEPHONE RD # 108
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2686
Practice Address - Country:US
Practice Address - Phone:805-647-6100
Practice Address - Fax:805-647-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty