Provider Demographics
NPI:1386839538
Name:EBRAHIMI, NADEREH H (DDS, MS)
Entity Type:Individual
Prefix:
First Name:NADEREH
Middle Name:H
Last Name:EBRAHIMI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 N FINE AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1528
Mailing Address - Country:US
Mailing Address - Phone:559-457-5800
Mailing Address - Fax:559-457-5894
Practice Address - Street 1:302 FRESNO ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3600
Practice Address - Country:US
Practice Address - Phone:559-457-5700
Practice Address - Fax:559-457-5790
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA562931223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics