Healthcare Provider Details

I. General information

NPI: 1568917110
Provider Name (Legal Business Name): MORRIS NIMA GHERMEZI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E DEL AMO BLVD
CARSON CA
90746-3314
US

IV. Provider business mailing address

328 S MAPLE DR
BEVERLY HILLS CA
90212-4610
US

V. Phone/Fax

Practice location:
  • Phone: 310-515-5672
  • Fax:
Mailing address:
  • Phone: 310-415-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS100474
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS100474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: