Provider Demographics
NPI:1770622912
Name:JAVID, NIKZAD SABET (DMD)
Entity type:Individual
Prefix:DR
First Name:NIKZAD
Middle Name:SABET
Last Name:JAVID
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 W POLSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0290
Mailing Address - Country:US
Mailing Address - Phone:559-298-7375
Mailing Address - Fax:559-298-7570
Practice Address - Street 1:200 W SHAW AVE STE 110
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3684
Practice Address - Country:US
Practice Address - Phone:559-325-6161
Practice Address - Fax:559-325-6166
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA36563OtherCALIFORNIA DENTAL L.