Provider Demographics
NPI:1609071216
Name:NADI, MARIAM (DDS)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:NADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 W ESTATES LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90274
Mailing Address - Country:US
Mailing Address - Phone:310-539-1111
Mailing Address - Fax:310-539-4111
Practice Address - Street 1:3614 W ESTATES LN UNIT A
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-4148
Practice Address - Country:US
Practice Address - Phone:310-539-1111
Practice Address - Fax:310-539-4111
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice