Provider Demographics
NPI:1184340242
Name:ATTARAN, NASIM (DMD)
Entity type:Individual
Prefix:DR
First Name:NASIM
Middle Name:
Last Name:ATTARAN
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 1:6 WOODSIDE LANE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H9H 3G6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 S MILLS RD
Practice Address - Street 2:101
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-643-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA63151Medicaid