Provider Demographics
NPI:1083829188
Name:DANESHMAND, NAZANIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAZANIN
Middle Name:
Last Name:DANESHMAND
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 1:3903 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2614
Mailing Address - Country:US
Mailing Address - Phone:562-427-2478
Mailing Address - Fax:562-981-9258
Practice Address - Street 1:3903 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2614
Practice Address - Country:US
Practice Address - Phone:562-427-2478
Practice Address - Fax:562-981-9258
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA454491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics