Provider Demographics
NPI:1790967115
Name:FATHI, SHEILA LAURA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:LAURA
Last Name:FATHI
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 1:375 ROLLING OAKS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1025
Mailing Address - Country:US
Mailing Address - Phone:805-496-6177
Mailing Address - Fax:805-496-6887
Practice Address - Street 1:375 ROLLING OAKS DR STE 120
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1025
Practice Address - Country:US
Practice Address - Phone:805-496-6177
Practice Address - Fax:805-496-6887
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist