Provider Demographics
NPI:1710533401
Name:DEHDAR NASAB, NEGIN (DMD)
Entity Type:Individual
Prefix:
First Name:NEGIN
Middle Name:
Last Name:DEHDAR NASAB
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 1:22121 BROOKPINE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1085
Mailing Address - Country:US
Mailing Address - Phone:240-491-6387
Mailing Address - Fax:
Practice Address - Street 1:22121 BROOKPINE
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1085
Practice Address - Country:US
Practice Address - Phone:240-491-6387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS103839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist