Provider Demographics
NPI:1770700098
Name:NAZIR, RAIHAN MOHAMMED (DDS, MSC)
Entity type:Individual
Prefix:DR
First Name:RAIHAN
Middle Name:MOHAMMED
Last Name:NAZIR
Suffix:
Gender:M
Credentials:DDS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S VILLA REAL
Mailing Address - Street 2:SUITE 101-B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3445
Mailing Address - Country:US
Mailing Address - Phone:714-974-4332
Mailing Address - Fax:
Practice Address - Street 1:505 S VILLA REAL STE 101B
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3432
Practice Address - Country:US
Practice Address - Phone:714-974-4332
Practice Address - Fax:714-921-3194
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45156122300000X, 261QD0000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentist
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427714252OtherNPT TYPE 2
CA45156OtherDENTIST