Provider Demographics
NPI:1841492576
Name:NIKNAM, DALIA (DDS)
Entity type:Individual
Prefix:
First Name:DALIA
Middle Name:
Last Name:NIKNAM
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 1:3662 KATELLA AVE.
Mailing Address - Street 2:SUITE202
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3189
Mailing Address - Country:US
Mailing Address - Phone:562-799-9535
Mailing Address - Fax:562-799-9536
Practice Address - Street 1:3662 KATELLA AVE
Practice Address - Street 2:SUITE202
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3124
Practice Address - Country:US
Practice Address - Phone:562-799-9535
Practice Address - Fax:562-799-9536
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist