MEDICARE: AMIR NIKRAZ DDS, INC.

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	46118	CA

General Provider Information

NPI Number	:	1871631408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIR NIKRAZ DDS, INC.

Provider Business Mailing Address
First Line	:	439 N EL CAMINO REAL
Second Line	:	SUITE # E
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4700
Country	:	US
Telephone Number	:	949-366-1177
Fax Number	:	949-366-1143

Provider Business Practice Location Address
First Line	:	439 N EL CAMINO REAL
Second Line	:	SUITE # E
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4700
Country	:	US
Telephone Number	:	949-366-1177
Fax Number	:	949-366-1143

Authorized Official
Title or Position	:	CEO
Name	:	DR. AMIR H. NIKRAZ
Credential	:	D.D.S.
Telephone Number	:	949-366-1177

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	08/22/2020

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