Organization
FARDAD TAYEBATY DMD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARDAD TAYEBATY DMD (PRESIDENT)
(617) 875-3211
Entity
Organization
Contact information
Practice address
390 S GREEN VALLEY RD STE 7, WATSONVILLE, CA 95076-3077
(831) 536-5880
Mailing address
5700 VILLAGE OAKS DR APT 1408, SAN JOSE, CA 95123-3778
(617) 875-3211
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
100912
CA
Other
Enumeration date
10/31/2017
Last updated
10/31/2017
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