Provider Demographics
NPI:1770756751
Name:HATAMI-FARD, KARIN S (DDS)
Entity type:Individual
Prefix:DR
First Name:KARIN
Middle Name:S
Last Name:HATAMI-FARD
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 1:5 E CITRUS AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4720
Mailing Address - Country:US
Mailing Address - Phone:909-581-4466
Mailing Address - Fax:
Practice Address - Street 1:5 E CITRUS AVE STE 204
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4720
Practice Address - Country:US
Practice Address - Phone:909-581-4466
Practice Address - Fax:909-798-3779
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice