Provider Demographics
NPI:1063965614
Name:HABIBI, NATALIA C (DMD)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:C
Last Name:HABIBI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 OFALLON RD STE 80
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8107
Mailing Address - Country:US
Mailing Address - Phone:636-244-4052
Mailing Address - Fax:
Practice Address - Street 1:810 OFALLON RD STE 80
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-8107
Practice Address - Country:US
Practice Address - Phone:636-244-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017012882122300000X
MADN1859245122300000X
IL0190309121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist