Provider Demographics
NPI:1760168587
Name:KERMANI, FATEMA
Entity Type:Individual
Prefix:
First Name:FATEMA
Middle Name:
Last Name:KERMANI
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 1:452 E MEAD DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5330
Mailing Address - Country:US
Mailing Address - Phone:502-409-2880
Mailing Address - Fax:
Practice Address - Street 1:808 N MISSION PKWY
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85194
Practice Address - Country:US
Practice Address - Phone:520-426-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist