Provider Demographics
NPI:1720539042
Name:K. JAVID DDS & M NADI DDS INC
Entity Type:Organization
Organization Name:K. JAVID DDS & M NADI DDS INC
Other - Org Name:DR. SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYVON
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-548-8128
Mailing Address - Street 1:1622 S GAFFEY ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-4658
Mailing Address - Country:US
Mailing Address - Phone:310-548-8128
Mailing Address - Fax:310-539-4111
Practice Address - Street 1:1622 S GAFFEY ST
Practice Address - Street 2:SUITE #102
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-4658
Practice Address - Country:US
Practice Address - Phone:310-548-8128
Practice Address - Fax:310-539-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty