Provider Demographics
NPI:1225540180
Name:DR FATEMEH HADJIAN D.D.S. P.A.
Entity Type:Organization
Organization Name:DR FATEMEH HADJIAN D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S. P.A.
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATEMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HADJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:760-568-6900
Mailing Address - Street 1:74000 COUNTRY CLUB STE B1
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260
Mailing Address - Country:US
Mailing Address - Phone:760-568-6900
Mailing Address - Fax:760-568-6914
Practice Address - Street 1:74000 COUNTRY CLUB STE B1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-568-6900
Practice Address - Fax:760-568-6914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51212122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty