Healthcare Provider Details

I. General information

NPI: 1174724447
Provider Name (Legal Business Name): MEDHAT N. NAHED, DDS, MS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E. FOOTHILL BLVD
ARCADIA CA
91006
US

IV. Provider business mailing address

45 E FOOTHILL BLVD
ARCADIA CA
91006-2307
US

V. Phone/Fax

Practice location:
  • Phone: 626-294-9119
  • Fax: 626-294-9241
Mailing address:
  • Phone: 626-294-9119
  • Fax: 626-294-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number46302
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number46302
License Number StateCA

VIII. Authorized Official

Name: JULIE G ALEMIAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-294-9119