Provider Demographics
NPI:1437298544
Name:FAY, MEHRDAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:FAY
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 1:323 E BULLARD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5286
Mailing Address - Country:US
Mailing Address - Phone:559-439-9990
Mailing Address - Fax:559-439-9996
Practice Address - Street 1:323 E BULLARD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5286
Practice Address - Country:US
Practice Address - Phone:559-439-9990
Practice Address - Fax:559-439-9996
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice