Provider Demographics
NPI:1730458712
Name:HANITABATABAEI, FARZANEH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:FARZANEH
Middle Name:
Last Name:HANITABATABAEI
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:PO BOX 14473
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-4473
Mailing Address - Country:US
Mailing Address - Phone:949-407-4334
Mailing Address - Fax:
Practice Address - Street 1:11702 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3609
Practice Address - Country:US
Practice Address - Phone:714-898-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist