Provider Demographics
NPI:1952787285
Name:FABIYI, SIMIADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMIADE
Middle Name:
Last Name:FABIYI
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 1:441 DIAZ AVE
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-4121
Mailing Address - Country:US
Mailing Address - Phone:661-725-3882
Mailing Address - Fax:661-721-2486
Practice Address - Street 1:441 DIAZ AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-4121
Practice Address - Country:US
Practice Address - Phone:661-725-3882
Practice Address - Fax:661-721-2486
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA649351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice