Provider Demographics
NPI:1598810004
Name:NICKY M HAKIMI DDS INC
Entity Type:Organization
Organization Name:NICKY M HAKIMI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICKY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAKIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:916-788-1114
Mailing Address - Street 1:1420 E ROSEVILLE PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3078
Mailing Address - Country:US
Mailing Address - Phone:916-788-1114
Mailing Address - Fax:916-788-1353
Practice Address - Street 1:1420 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3078
Practice Address - Country:US
Practice Address - Phone:916-788-1114
Practice Address - Fax:916-788-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty