Provider Demographics
NPI:1730284985
Name:NAEIMI, PANTEA (DDS)
Entity Type:Individual
Prefix:
First Name:PANTEA
Middle Name:
Last Name:NAEIMI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W BENJAMIN HOLT DR
Mailing Address - Street 2:BUILDING B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2171 JUNIPERO SERRA BLVD
Practice Address - Street 2:#660
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-1906
Practice Address - Country:US
Practice Address - Phone:650-992-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice