Provider Demographics
NPI:1942311568
Name:MARTIN S NAHIGIAN DDS INC
Entity Type:Organization
Organization Name:MARTIN S NAHIGIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-227-8434
Mailing Address - Street 1:1569 WEST SHAW AVENUE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3503
Mailing Address - Country:US
Mailing Address - Phone:559-227-8434
Mailing Address - Fax:559-227-6246
Practice Address - Street 1:1569 WEST SHAW AVENUE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3503
Practice Address - Country:US
Practice Address - Phone:559-227-8434
Practice Address - Fax:559-227-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA241700OtherDENTI-CAL -PIN
CAB2457501OtherDENTI-CAL # (BILLING)
CAB2457501Medicaid
CA241700Medicaid
CAD2457501OtherDENTI-CAL # (RENDERING)
CAD2457501Medicaid