Provider Demographics
NPI:1265876544
Name:HADJIAN, FATEMEH (DDS, PA)
Entity type:Individual
Prefix:MRS
First Name:FATEMEH
Middle Name:
Last Name:HADJIAN
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74000 COUNTRY CLUB STE BL
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260
Mailing Address - Country:US
Mailing Address - Phone:760-568-6900
Mailing Address - Fax:760-568-6914
Practice Address - Street 1:74000 COUNTRY CLUB STE BL
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-568-6900
Practice Address - Fax:760-568-6914
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51212122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist