# F MOFTAKHAR DDS A PROFESSIONAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bay Area Dental Specialty Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063631109
- **Authorized official:** DR. FARSHAD MOFTAKHAR DDS (OWNER CEO)
- **Authorized official phone:** (626) 246-0150

## Contact information

- **Practice address:** 3301 E 12TH ST STE 163, OAKLAND, CA 94601-2939
- **Practice address phone:** (510) 533-1123
- **Practice address fax:** (510) 485-5109
- **Mailing address:** 1809 E ECKERMAN AVE, WEST COVINA, CA 91791-1112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 04/25/2007
- **Last updated:** 07/15/2008