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General NPI Number Information
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NPI Number | 1225105620
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Entity Type | Individual
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Provider Name | MARJAN FATHI DDS
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 205 DE ANZA BLVD #164
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City | SAN MATEO
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State | CA
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Zip | 94402-3989
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Country | US
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Telephone | 714-328-4609
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Fax |
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Provider Business Mailing Address
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Address Line | 205 DE ANZA BLVD #164
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City | SAN MATEO
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State | CA
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Zip | 94402-3989
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50748
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License Number State | CA
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