Individual
FARDAD TAYEBATY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
390 S GREEN VALLEY RD STE 7, WATSONVILLE, CA 95076-3077
(617) 875-3211
Mailing address
390 S GREEN VALLEY RD STE 7, WATSONVILLE, CA 95076-3077
(617) 875-3211
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
055815
NY
1223E0200X
Endodontics
Primary
100912
CA
1223E0200X
Endodontics
22DI02435200
NJ
1223G0001X
General Practice Dentistry
22292
MA
1223G0001X
General Practice Dentistry
22D102435200
NJ
Other
Enumeration date
07/03/2008
Last updated
04/09/2018
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