Provider Demographics
NPI:1245081835
Name:FATEMI, BAHAREH (DMD)
Entity type:Individual
Prefix:
First Name:BAHAREH
Middle Name:
Last Name:FATEMI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 EDGEWATER BLVD APT 301
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2843
Mailing Address - Country:US
Mailing Address - Phone:415-696-8444
Mailing Address - Fax:
Practice Address - Street 1:581 FOSTER CITY BLVD
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1695
Practice Address - Country:US
Practice Address - Phone:650-286-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1082721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty