Provider Demographics
NPI:1407911886
Name:VAFAIE, NADER MEHRA (DMD)
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:MEHRA
Last Name:VAFAIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HILL RD
Mailing Address - Street 2:SUITE #19
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4340
Mailing Address - Country:US
Mailing Address - Phone:415-209-6000
Mailing Address - Fax:415-209-6100
Practice Address - Street 1:1615 HILL RD
Practice Address - Street 2:SUITE #19
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4340
Practice Address - Country:US
Practice Address - Phone:415-209-6000
Practice Address - Fax:415-209-6100
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics