Provider Demographics
NPI:1528451903
Name:LAURA FATHI DDS
Entity type:Organization
Organization Name:LAURA FATHI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:FATHI
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:805-496-6177
Mailing Address - Street 1:375 ROLLING OAKS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1025
Mailing Address - Country:US
Mailing Address - Phone:805-496-6177
Mailing Address - Fax:805-496-6887
Practice Address - Street 1:375 ROLLING OAKS DR STE 120
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1025
Practice Address - Country:US
Practice Address - Phone:805-496-6177
Practice Address - Fax:805-496-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty