Provider Demographics
NPI:1295419216
Name:NAZERI, YALDA (DDS)
Entity type:Individual
Prefix:
First Name:YALDA
Middle Name:
Last Name:NAZERI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 S SYRACUSE WAY APT 1503
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6755
Mailing Address - Country:US
Mailing Address - Phone:720-206-8073
Mailing Address - Fax:
Practice Address - Street 1:1400 GROVE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2229
Practice Address - Country:US
Practice Address - Phone:303-825-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002056321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice