Provider Demographics
NPI:1588661151
Name:NEJAD, ABBAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:
Last Name:NEJAD
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 1:5130 W BASELINE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2988
Mailing Address - Country:US
Mailing Address - Phone:602-237-7878
Mailing Address - Fax:602-237-7771
Practice Address - Street 1:5130 W BASELINE RD STE 111
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2988
Practice Address - Country:US
Practice Address - Phone:602-237-7878
Practice Address - Fax:602-237-7771
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ48521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice