Provider Demographics
NPI:1760489660
Name:KAZI, FATIMA (DDS)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:KAZI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:FATIMA
Other - Middle Name:KAZI
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-360-6276
Mailing Address - Fax:303-467-5355
Practice Address - Street 1:7495 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-8002
Practice Address - Country:US
Practice Address - Phone:303-239-9964
Practice Address - Fax:303-237-4343
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00008299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15258530Medicaid