Provider Demographics
NPI:1275685604
Name:FAKHIMI, ALI (DMD)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:
Last Name:FAKHIMI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 CLAIREMONT MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2606
Mailing Address - Country:US
Mailing Address - Phone:858-274-8200
Mailing Address - Fax:858-274-5794
Practice Address - Street 1:3735 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-2606
Practice Address - Country:US
Practice Address - Phone:858-274-8200
Practice Address - Fax:858-274-5794
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice