Provider Demographics
NPI:1083999387
Name:NADAFI, LAURA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:NADAFI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LADAN
Other - Middle Name:
Other - Last Name:NADDAFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1736 N MOORPARK RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5135
Mailing Address - Country:US
Mailing Address - Phone:805-557-0909
Mailing Address - Fax:805-557-0908
Practice Address - Street 1:1736 N MOORPARK RD
Practice Address - Street 2:SUITE H
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5135
Practice Address - Country:US
Practice Address - Phone:805-557-0909
Practice Address - Fax:805-557-0908
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist