Provider Demographics
NPI:1891280129
Name:JAFARNEJAD, NAHVID (DMD)
Entity Type:Individual
Prefix:
First Name:NAHVID
Middle Name:
Last Name:JAFARNEJAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 N BASCOM AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1869
Mailing Address - Country:US
Mailing Address - Phone:408-243-5044
Mailing Address - Fax:
Practice Address - Street 1:189 N BASCOM AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1869
Practice Address - Country:US
Practice Address - Phone:408-243-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1026521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice