Provider Demographics
NPI:1629178694
Name:MEHR, NADER BAHARIAN (DDS)
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:BAHARIAN
Last Name:MEHR
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 1:13539 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3282
Mailing Address - Country:US
Mailing Address - Phone:714-890-1700
Mailing Address - Fax:714-890-1701
Practice Address - Street 1:13539 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3282
Practice Address - Country:US
Practice Address - Phone:714-890-1700
Practice Address - Fax:714-890-1701
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice