Provider Demographics
NPI:1336491356
Name:FATAFEHI, ROBIN WENDY (RDH, EPDH)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:WENDY
Last Name:FATAFEHI
Suffix:
Gender:F
Credentials:RDH, EPDH
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:WENDY
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH, EPDH
Mailing Address - Street 1:PO BOX 7014
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-7014
Mailing Address - Country:US
Mailing Address - Phone:503-440-2313
Mailing Address - Fax:
Practice Address - Street 1:20392 SW BLAINE CT
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-2115
Practice Address - Country:US
Practice Address - Phone:503-440-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6359124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist