Provider Demographics
NPI:1508609413
Name:NEDJAT-HAIEM DENTAL CORPORATION
Entity type:Organization
Organization Name:NEDJAT-HAIEM DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDJAT-HAIEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDENTSC
Authorized Official - Phone:310-666-9024
Mailing Address - Street 1:200 N SWALL DR UNIT 504
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-4725
Mailing Address - Country:US
Mailing Address - Phone:310-666-9024
Mailing Address - Fax:
Practice Address - Street 1:612 E CARSON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2912
Practice Address - Country:US
Practice Address - Phone:562-585-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEDJAT-HAIEM DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty