Provider Demographics
NPI:1598136889
Name:NASIBI HEYRANI DDS, INC.
Entity Type:Organization
Organization Name:NASIBI HEYRANI DDS, INC.
Other - Org Name:DREAMLAND DENTAL AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PEJMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIBI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-922-0221
Mailing Address - Street 1:16537 BELLFLOWER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5449
Mailing Address - Country:US
Mailing Address - Phone:562-867-2026
Mailing Address - Fax:
Practice Address - Street 1:16537 BELLFLOWER BLVD STE B
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5449
Practice Address - Country:US
Practice Address - Phone:562-867-2026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57456122300000X
1223E0200X, 1223P0106X, 1223P0221X
CA605751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty