Provider Demographics
NPI:1356572671
Name:NASSAR, CRYSTAL (DDS)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:NASSAR
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 1:518 BARSOTTI AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-3047
Mailing Address - Country:US
Mailing Address - Phone:559-674-2118
Mailing Address - Fax:
Practice Address - Street 1:518 BARSOTTI AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-3047
Practice Address - Country:US
Practice Address - Phone:559-674-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice