Provider Demographics
NPI:1275805574
Name:MIR, NAZISH (DDS)
Entity Type:Individual
Prefix:
First Name:NAZISH
Middle Name:
Last Name:MIR
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 1:20074 RAWHIDE WAY
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5117
Mailing Address - Country:US
Mailing Address - Phone:510-402-4937
Mailing Address - Fax:
Practice Address - Street 1:20074 RAWHIDE WAY
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-5117
Practice Address - Country:US
Practice Address - Phone:510-402-4937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist