Provider Demographics
NPI:1447347976
Name:FARISH, C. THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:C. THOMAS
Middle Name:
Last Name:FARISH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9764 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-4107
Mailing Address - Country:US
Mailing Address - Phone:818-899-5276
Mailing Address - Fax:818-834-5088
Practice Address - Street 1:9764 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-4107
Practice Address - Country:US
Practice Address - Phone:818-899-5276
Practice Address - Fax:818-834-5088
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice