Provider Demographics
NPI:1114594538
Name:NIKAEEN DENTAL CORPORATION
Entity Type:Organization
Organization Name:NIKAEEN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ATOOSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKAEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-225-8800
Mailing Address - Street 1:22949 VENTURA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1271
Mailing Address - Country:US
Mailing Address - Phone:818-225-8800
Mailing Address - Fax:818-225-8826
Practice Address - Street 1:22949 VENTURA BLVD STE C
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1271
Practice Address - Country:US
Practice Address - Phone:818-225-8800
Practice Address - Fax:818-225-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43378OtherDENTIST