Provider Demographics
NPI:1518187293
Name:NAZ, OMERA (D D S)
Entity Type:Individual
Prefix:DR
First Name:OMERA
Middle Name:
Last Name:NAZ
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 N RANCHO CT
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-1152
Mailing Address - Country:US
Mailing Address - Phone:510-222-5157
Mailing Address - Fax:510-222-5157
Practice Address - Street 1:4440 SAN PABLO DAM RD
Practice Address - Street 2:STE # A
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-3052
Practice Address - Country:US
Practice Address - Phone:510-223-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice