Provider Demographics
NPI:1881321081
Name:GHANI, FATIMA (DDS)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:GHANI
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 1:10833 WILSHIRE BLVD APT 330
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4395
Mailing Address - Country:US
Mailing Address - Phone:312-810-7855
Mailing Address - Fax:
Practice Address - Street 1:10833 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4380
Practice Address - Country:US
Practice Address - Phone:312-810-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist