Provider Demographics
NPI:1538300249
Name:KHADAVI, NATALIE DEBORAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:DEBORAH
Last Name:KHADAVI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 STINE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-6341
Mailing Address - Country:US
Mailing Address - Phone:661-377-6453
Mailing Address - Fax:
Practice Address - Street 1:3450 STINE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-6341
Practice Address - Country:US
Practice Address - Phone:661-377-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist