Provider Demographics
NPI:1750515656
Name:NAHIGIAN, MARTIN SIMON (DDS)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:SIMON
Last Name:NAHIGIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:SIMON
Other - Last Name:NAHIGIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1569 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3503
Mailing Address - Country:US
Mailing Address - Phone:559-227-8434
Mailing Address - Fax:559-227-6246
Practice Address - Street 1:1569 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3503
Practice Address - Country:US
Practice Address - Phone:559-227-8434
Practice Address - Fax:559-227-6246
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB24575-01Medicaid