Provider Demographics
NPI:1568656148
Name:HAFEZI, MARYANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:HAFEZI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28365 DAVIS PARKWAY
Mailing Address - Street 2:FAMILY FIRST DENTAL LLC SUITE 206
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555
Mailing Address - Country:US
Mailing Address - Phone:630-836-8995
Mailing Address - Fax:630-836-8996
Practice Address - Street 1:28365 DAVIS PKWY
Practice Address - Street 2:STE 206
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555
Practice Address - Country:US
Practice Address - Phone:630-836-8995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190254271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice