Provider Demographics
NPI:1417038654
Name:ATTAIE, NAZANIN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:NAZANIN
Middle Name:
Last Name:ATTAIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4651
Mailing Address - Country:US
Mailing Address - Phone:916-663-6035
Mailing Address - Fax:
Practice Address - Street 1:825 E BIDWELL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3349
Practice Address - Country:US
Practice Address - Phone:916-984-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice