Provider Demographics
NPI:1649401514
Name:TARJAN, NAZELI (DDS)
Entity type:Individual
Prefix:
First Name:NAZELI
Middle Name:
Last Name:TARJAN
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 1:8580 SCARBOROUGH DR.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-528-5577
Mailing Address - Fax:719-528-5621
Practice Address - Street 1:8580 SCARBOROUGH DR.
Practice Address - Street 2:SUITE 105
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-528-5577
Practice Address - Fax:719-528-5621
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66341223G0001X
CO99701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice