Provider Demographics
NPI:1285066548
Name:FADAEI, BEHZAD (DDS)
Entity type:Individual
Prefix:
First Name:BEHZAD
Middle Name:
Last Name:FADAEI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6265 SEPULVEDA BLVD #14
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411
Mailing Address - Country:US
Mailing Address - Phone:818-983-4021
Mailing Address - Fax:
Practice Address - Street 1:6265 SEPULVEDA BLVD #14
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411
Practice Address - Country:US
Practice Address - Phone:818-787-6787
Practice Address - Fax:818-922-2525
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist