Provider Demographics
NPI:1598185456
Name:SADAT, FAHTEMA
Entity Type:Individual
Prefix:
First Name:FAHTEMA
Middle Name:
Last Name:SADAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 W. RIVERSIDE DR
Mailing Address - Street 2:SUITE #501
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-0053
Mailing Address - Country:US
Mailing Address - Phone:818-779-0299
Mailing Address - Fax:
Practice Address - Street 1:3808 W. RIVERSIDE DR
Practice Address - Street 2:SUITE #501
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-0053
Practice Address - Country:US
Practice Address - Phone:818-779-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist