Provider Demographics
NPI:1790194348
Name:SADEGHI, NASIR
Entity Type:Individual
Prefix:DR
First Name:NASIR
Middle Name:
Last Name:SADEGHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 N 1ST ST STE 109
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0517
Mailing Address - Country:US
Mailing Address - Phone:559-229-6249
Mailing Address - Fax:
Practice Address - Street 1:2747 W BULLARD AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2279
Practice Address - Country:US
Practice Address - Phone:559-392-7393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice