Provider Demographics
NPI:1023176195
Name:NASR, HAMID REZA (DDS)
Entity type:Individual
Prefix:DR
First Name:HAMID
Middle Name:REZA
Last Name:NASR
Suffix:
Gender:M
Credentials:DDS
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 6535
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-6535
Mailing Address - Country:US
Mailing Address - Phone:916-983-8777
Mailing Address - Fax:916-983-2096
Practice Address - Street 1:1625 CREEKSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3819
Practice Address - Country:US
Practice Address - Phone:916-983-8777
Practice Address - Fax:916-983-2096
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice