Provider Demographics
NPI:1912019464
Name:DOROODIAN, NAZILA (DMD)
Entity Type:Individual
Prefix:
First Name:NAZILA
Middle Name:
Last Name:DOROODIAN
Suffix:
Gender:F
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:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94023
Mailing Address - Country:US
Mailing Address - Phone:650-561-9212
Mailing Address - Fax:
Practice Address - Street 1:3301 EL CAMINO REAL
Practice Address - Street 2:STE 280
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027
Practice Address - Country:US
Practice Address - Phone:650-562-0590
Practice Address - Fax:650-562-0596
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice