Healthcare Provider Details

I. General information

NPI: 1710413745
Provider Name (Legal Business Name): AMIN NASEHI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 S U ST STE 101A
FORT SMITH AR
72903-3613
US

IV. Provider business mailing address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-8800
  • Fax: 479-452-8800
Mailing address:
  • Phone: 313-494-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4441
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901602642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: