Provider Demographics
NPI:1760578769
Name:NADI, HAMID (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:
Last Name:NADI
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 1:3301 W. BEVERLY BLVD.
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1536
Mailing Address - Country:US
Mailing Address - Phone:323-722-6766
Mailing Address - Fax:323-722-2022
Practice Address - Street 1:3301 W. BEVERLY BLVD.
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1536
Practice Address - Country:US
Practice Address - Phone:323-722-6766
Practice Address - Fax:323-722-2022
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506501223S0112X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery