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General NPI Number Information
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NPI Number | 1881191419
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Entity Type | Organization
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Legal Business Name | PEYMAN FATTAHI DDS LLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 1301 NW WASHINGTON BLVD STE 1
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City | HAMILTON
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State | OH
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Zip | 45013-6309
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Country | US
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Telephone | 513-868-0669
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 FLOWERDALE AVE
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City | KETTERING
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State | OH
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Zip | 45429-5102
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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 | DENTIST
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Name | DR. PEYMAN FATTAHI
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Credential | DDS
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Telephone | 937-474-2972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 30-024177
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License Number State | OH
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