Provider Demographics
NPI:1518033471
Name:NAZARI, REZA (DDS)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:NAZARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 OLD 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-2002
Mailing Address - Country:US
Mailing Address - Phone:510-386-8212
Mailing Address - Fax:
Practice Address - Street 1:2677 OLD 1ST ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-2002
Practice Address - Country:US
Practice Address - Phone:925-447-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice