Provider Demographics
NPI:1093847204
Name:BEHESHTI, FATEMEH (DDS)
Entity type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:BEHESHTI
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 1:7070 MARLBOROUGH TER
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1735
Mailing Address - Country:US
Mailing Address - Phone:510-704-0444
Mailing Address - Fax:510-704-0444
Practice Address - Street 1:145 E 14TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1661
Practice Address - Country:US
Practice Address - Phone:510-635-9204
Practice Address - Fax:510-635-9518
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist