Taufik Farady Iskaq, D.D.S.

Individual provider Active NPI General Practice Dentistry · Upland, CA

NPI 1356469944 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1356469944
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
35125 (CA)
Practice address
495 N. Central Ave.,
Suite a
Upland, CA 91786-4219
Phone
(909) 931-2600
Fax
(909) 931-2605
NPI assigned
Mar 26, 2007
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
35125CAMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 35125 CA Yes

Addresses

Primary practice location

495 N. Central Ave.,
Suite a
Upland, CA 91786-4219

Mailing address

495 N. Central Ave.,
Suite a
Upland, CA 91786-4219
Phone (909) 931-2600

Other providers in Upland, CA

All providers in Upland, CA · General Practice Dentistry in California

Sources for this page

Verify at the official NPI Registry.