Farbod Dadkhah Tirani, DMD
Individual provider Active NPI Dentist · McClellan, CA
NPI 1740969112 · NPPES record last updated Sep 12, 2024
Key facts
- NPI
- 1740969112
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D012286 (AZ)
- Practice address
- 5401 Arnold Ave # 88
McClellan, CA 95652-1018 - Phone
- (916) 333-5500
- NPI assigned
- Jul 13, 2023
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D012286 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chandler Dental Partners LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D012286 | AZ | Yes |
Addresses
Primary practice location
5401 Arnold Ave # 88
McClellan, CA 95652-1018
Mailing address
5401 Arnold Ave # 88
McClellan, CA 95652-1018
Other providers in McClellan, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.