Provider Demographics
NPI:1346510617
Name:NAZILA DOROODIAN DMD INC
Entity Type:Organization
Organization Name:NAZILA DOROODIAN DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOROODIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-562-0590
Mailing Address - Street 1:3301 EL CAMINO REAL STE 280
Mailing Address - Street 2:
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3803
Mailing Address - Country:US
Mailing Address - Phone:650-562-0590
Mailing Address - Fax:650-562-0596
Practice Address - Street 1:3301 EL CAMINO REAL STE 280
Practice Address - Street 2:
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3803
Practice Address - Country:US
Practice Address - Phone:650-562-0590
Practice Address - Fax:650-562-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty