Provider Demographics
NPI:1619022936
Name:NASIRY, AREZOO (DMD)
Entity Type:Individual
Prefix:DR
First Name:AREZOO
Middle Name:
Last Name:NASIRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W 136TH ST
Mailing Address - Street 2:6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7901
Mailing Address - Country:US
Mailing Address - Phone:718-824-3403
Mailing Address - Fax:
Practice Address - Street 1:3377 WILSHIRE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1852
Practice Address - Country:US
Practice Address - Phone:213-385-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000351223G0001X
CA481531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26-3300578OtherTIN