Provider Demographics
NPI:1902999576
Name:FATEHI, SCHAHROKH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCHAHROKH
Middle Name:
Last Name:FATEHI
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 1:25411 CABOT RD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5520
Mailing Address - Country:US
Mailing Address - Phone:949-472-3737
Mailing Address - Fax:949-472-3667
Practice Address - Street 1:25411 CABOT RD
Practice Address - Street 2:SUITE #108
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5520
Practice Address - Country:US
Practice Address - Phone:949-472-3737
Practice Address - Fax:949-472-3667
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery