Provider Demographics
NPI:1861010928
Name:FARHADIAN, PARDIS LIPKIN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PARDIS
Middle Name:LIPKIN
Last Name:FARHADIAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:PARDIS
Other - Middle Name:L
Other - Last Name:FARHADIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:90 MIDDLEFIELD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4001
Mailing Address - Country:US
Mailing Address - Phone:650-323-0264
Mailing Address - Fax:
Practice Address - Street 1:90 MIDDLEFIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4001
Practice Address - Country:US
Practice Address - Phone:650-323-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104621390200000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program