Provider Demographics
NPI:1194818815
Name:MIRZAYAN, NINA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:L
Last Name:MIRZAYAN
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 1:1701 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE 8-E
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5885
Mailing Address - Country:US
Mailing Address - Phone:702-492-1955
Mailing Address - Fax:702-492-7663
Practice Address - Street 1:1701 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 8-E
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5885
Practice Address - Country:US
Practice Address - Phone:702-492-1955
Practice Address - Fax:702-492-7663
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV43651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice