Haleh Fazeli, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

103470 Issued in CA

Practice address

330 Park Ave Ste 10
Laguna Beach, CA 92651-2352

Phone

(443) 896-6203

NPI assigned

Jun 22, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Haleh Fazeli-Tehrani Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Laguna Beach Dental Excellence

  • Dental Clinic/Center
  • Laguna Beach, CA
  • NPI 1124776604
  NPD Authorized official

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

{
    "created_epoch": "1340323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1841553914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 PARK AVE STE 10",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926512352",
            "telephone_number": "443-896-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 PARK AVE STE 10",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926512352",
            "telephone_number": "443-896-6203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 Woodland Ave",
            "address_2": "Dental Service, VAMC (160)",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-823-5800 x6941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAZELI",
        "first_name": "HALEH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-22",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039609",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "103470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HALEH",
            "last_name": "FAZELI-TEHRANI",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mark Steven Falcone, M.D.
• Alexander Hao Fan, M.D.
• Elliott Fankuchen, M.D.
• Fassino, Inc. (Coastline Health and Chiropractic)
• Bertha America Favela III, DDS
• Taylor Fazen
• Shayna Rachel Feinerman, RDN
• Michael Jay Fine, M.D.
• Anthony Flowers
• Kimberly Vermillion Fogarty, JD, MA, BC-TMH

• Dentist in Laguna Beach, CA
• Providers in Laguna Beach, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.