Provider Demographics
NPI:1245379114
Name:NASIM, MIR JAMSHED (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIR
Middle Name:JAMSHED
Last Name:NASIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:NASIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:108 BURTON STREET
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301
Mailing Address - Country:US
Mailing Address - Phone:864-576-7169
Mailing Address - Fax:864-576-7996
Practice Address - Street 1:108 BURTON STREET
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301
Practice Address - Country:US
Practice Address - Phone:864-576-7169
Practice Address - Fax:864-576-7996
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX2881Medicaid