Provider Demographics
NPI:1225171499
Name:NADERSHAHI, FATAMEH NILOUFAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:FATAMEH
Middle Name:NILOUFAR
Last Name:NADERSHAHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:FATAMEH
Other - Middle Name:NILOUFAR
Other - Last Name:EGHTESSADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:122 TUNSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2622
Mailing Address - Country:US
Mailing Address - Phone:415-459-0114
Mailing Address - Fax:415-459-2717
Practice Address - Street 1:122 TUNSTEAD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2622
Practice Address - Country:US
Practice Address - Phone:415-459-0114
Practice Address - Fax:415-459-2717
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist