Provider Demographics
NPI:1952329104
Name:BEHESHTI, NEZAM M (DMD)
Entity Type:Individual
Prefix:
First Name:NEZAM
Middle Name:M
Last Name:BEHESHTI
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 1:6663 MING AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-3491
Mailing Address - Country:US
Mailing Address - Phone:661-831-0800
Mailing Address - Fax:661-831-4994
Practice Address - Street 1:DENTAL OFFICE OF DR. BEHESHTI
Practice Address - Street 2:6663 MING AVE.
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-831-0800
Practice Address - Fax:661-831-4994
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37083OtherDENTAL LICENSE