Provider Demographics
NPI:1508460742
Name:TAHERI, NAZLIE (DDS)
Entity Type:Individual
Prefix:
First Name:NAZLIE
Middle Name:
Last Name:TAHERI
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 1:3 TOSCANA DR
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1470
Mailing Address - Country:US
Mailing Address - Phone:415-900-7362
Mailing Address - Fax:
Practice Address - Street 1:3083 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-4510
Practice Address - Country:US
Practice Address - Phone:707-257-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice