Provider Demographics
NPI:1629027537
Name:NIKRAZ, AMIR HOSSEIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:HOSSEIN
Last Name:NIKRAZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 N EL CAMINO REAL
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4700
Mailing Address - Country:US
Mailing Address - Phone:949-366-1177
Mailing Address - Fax:949-366-1143
Practice Address - Street 1:439 N EL CAMINO REAL
Practice Address - Street 2:SUITE E
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4700
Practice Address - Country:US
Practice Address - Phone:949-366-1177
Practice Address - Fax:949-366-1143
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist