Provider Demographics
NPI:1487913471
Name:MATT G. FARZIN DDS, INC
Entity type:Organization
Organization Name:MATT G. FARZIN DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:G
Authorized Official - Last Name:FARZIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-812-8014
Mailing Address - Street 1:2969 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3912
Mailing Address - Country:US
Mailing Address - Phone:714-437-1100
Mailing Address - Fax:714-437-1101
Practice Address - Street 1:2969 HARBOR BLVD.
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-437-1100
Practice Address - Fax:714-437-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty