Provider Demographics
NPI:1073778494
Name:NADER AFSHARI DDS & SOHEIL AMIROAZZAMI DDS A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:NADER AFSHARI DDS & SOHEIL AMIROAZZAMI DDS A PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRMOAZZAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-242-3626
Mailing Address - Street 1:16127 KASOTA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2204
Mailing Address - Country:US
Mailing Address - Phone:760-242-3626
Mailing Address - Fax:760-242-5609
Practice Address - Street 1:16127 KASOTA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2204
Practice Address - Country:US
Practice Address - Phone:760-242-3626
Practice Address - Fax:760-242-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty