Provider Demographics
NPI:1568470839
Name:FATEHI, FARSCHID (DDS)
Entity Type:Individual
Prefix:MR
First Name:FARSCHID
Middle Name:
Last Name:FATEHI
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 1:800 CORPORATE DR
Mailing Address - Street 2:STE 240
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694
Mailing Address - Country:US
Mailing Address - Phone:949-347-1166
Mailing Address - Fax:949-347-1144
Practice Address - Street 1:800 CORPORATE DR
Practice Address - Street 2:STE 240
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694
Practice Address - Country:US
Practice Address - Phone:949-347-1166
Practice Address - Fax:949-347-1144
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist