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General NPI Number Information
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NPI Number | 1215450085
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Entity Type | Organization
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Legal Business Name | S FATAHI DENTAL GROUP INC
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 24121 BAYWOOD LN STE A
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City | VALENCIA
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State | CA
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Zip | 91355-6114
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Country | US
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Telephone | 661-291-1200
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Fax | 661-291-1266
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Provider Business Mailing Address
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Address Line | 24121 BAYWOOD LN STE A
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City | VALENCIA
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State | CA
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Zip | 91355-6114
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Country | US
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Telephone | 661-291-1200
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Fax | 661-291-1266
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Authorized Official
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Title or Position | PRESIDENT
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Name | SEPI FATAHI
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Credential | DMD
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Telephone | 661-964-8786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61574
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License Number State | CA
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