NPIMap

Organization Active NPI

Fareid Dental Corporation

  • General Practice Dentistry
  • Visalia, CA
National Provider Identifier
1265839831
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FAREID DENTAL CORPORATION
Practice address
4129 S Mooney Blvd
Suite B
Visalia, CA 93277-9147
Phone
(559) 732-1953
Fax
(559) 732-1983
NPI assigned
Nov 26, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bevan S Fareid, DDS
Title
Owner
Phone
(559) 732-1953

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4129 S Mooney Blvd
Suite B
Visalia, CA 93277-9147

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8890

Other names 1

  • Packwood Creek Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

4129 S Mooney Blvd
#B
Visalia, CA 93277
Phone (559) 732-1953

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1265839831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4129 S MOONEY BLVD",
            "address_2": "SUITE B",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932779147",
            "telephone_number": "559-732-1953",
            "fax_number": "559-732-1983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAREID DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-26",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "FAREID",
        "authorized_official_first_name": "BEVAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "559-732-1953",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Packwood Creek Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Packwood Creek Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Visalia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.