Provider Demographics
NPI:1396078978
Name:AFSHAR, FATEMEH (DDS)
Entity type:Individual
Prefix:MRS
First Name:FATEMEH
Middle Name:
Last Name:AFSHAR
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 1:430 MILWAUKEE AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3015
Mailing Address - Country:US
Mailing Address - Phone:847-478-9640
Mailing Address - Fax:847-478-9642
Practice Address - Street 1:430 MILWAUKEE AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3015
Practice Address - Country:US
Practice Address - Phone:847-478-9640
Practice Address - Fax:847-478-9642
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190252211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice