Provider Demographics
NPI:1609205426
Name:VIDA NAMAVAR D.D.S., INC.
Entity Type:Organization
Organization Name:VIDA NAMAVAR D.D.S., INC.
Other - Org Name:VIDA FAMILY DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-850-9320
Mailing Address - Street 1:670 W SAN MARCOS BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1235
Mailing Address - Country:US
Mailing Address - Phone:619-850-9320
Mailing Address - Fax:
Practice Address - Street 1:670 W SAN MARCOS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1235
Practice Address - Country:US
Practice Address - Phone:619-850-9320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty