# FARDAD TAYEBATY DMD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114439015
- **Authorized official:** FARDAD TAYEBATY DMD (PRESIDENT)
- **Authorized official phone:** (617) 875-3211

## Contact information

- **Practice address:** 390 S GREEN VALLEY RD STE 7, WATSONVILLE, CA 95076-3077
- **Practice address phone:** (831) 536-5880
- **Mailing address:** 5700 VILLAGE OAKS DR APT 1408, SAN JOSE, CA 95123-3778
- **Mailing address phone:** (617) 875-3211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 100912 | CA | Yes |

## Other

- **Enumeration date:** 10/31/2017
- **Last updated:** 10/31/2017