Provider Demographics
NPI:1275908253
Name:NAZARETH DENTAL
Entity Type:Organization
Organization Name:NAZARETH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUHAIR
Authorized Official - Middle Name:SALIM
Authorized Official - Last Name:HANHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-871-5217
Mailing Address - Street 1:800 S B ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4273
Mailing Address - Country:US
Mailing Address - Phone:650-871-5217
Mailing Address - Fax:650-588-6590
Practice Address - Street 1:800 S B ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4273
Practice Address - Country:US
Practice Address - Phone:650-871-5217
Practice Address - Fax:650-588-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52989261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902974397OtherNPPES