Provider Demographics
NPI:1336538016
Name:MOORMEHEI, FATEMEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:FATEMEH
Middle Name:
Last Name:MOORMEHEI
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 1:5084 N FRUIT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3000
Mailing Address - Country:US
Mailing Address - Phone:559-226-3686
Mailing Address - Fax:559-226-0947
Practice Address - Street 1:1010 SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3950
Practice Address - Country:US
Practice Address - Phone:281-701-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist