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Organization
FARWEST DENTAL GROUP
Active
Organization
FARWEST DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HASSAN FAYOUMI DDS (ONWER)
(310) 699-1549
Entity
Organization
Contact information
Practice address
1704 N AVALON BLVD, WILMINGTON, CA 90744-1433
(310) 835-5130
(310) 835-6090
Mailing address
1704 N AVALON BLVD, WILMINGTON, CA 90744-1433
(310) 835-5130
(310) 835-6090
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
52604
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G8983901
—
CA
Enumeration date
04/20/2017
Last updated
04/20/2017
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