Provider Demographics
NPI:1306384938
Name:NAJMEH HANNANVASH DDS, INC
Entity Type:Organization
Organization Name:NAJMEH HANNANVASH DDS, INC
Other - Org Name:LITTLE STAR PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NAJMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNANVASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:619-630-4000
Mailing Address - Street 1:5550 CARMEL MOUNTAIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4861
Mailing Address - Country:US
Mailing Address - Phone:619-630-4000
Mailing Address - Fax:619-630-0241
Practice Address - Street 1:5550 CARMEL MOUNTAIN RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4861
Practice Address - Country:US
Practice Address - Phone:619-630-4000
Practice Address - Fax:619-630-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA613241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty