MEDICARE: DR. ABBAS NEJAD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	AZ4852	AZ

General Provider Information

NPI Number	:	1588661151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABBAS NEJAD DDS

Provider Business Mailing Address
First Line	:	5130 W BASELINE RD STE 111
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-2988
Country	:	US
Telephone Number	:	602-237-7878
Fax Number	:	602-237-7771

Provider Business Practice Location Address
First Line	:	5130 W BASELINE RD STE 111
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-2988
Country	:	US
Telephone Number	:	602-237-7878
Fax Number	:	602-237-7771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/02/2019

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