Healthcare Provider Details

I. General information

NPI: 1508609413
Provider Name (Legal Business Name): NEDJAT-HAIEM DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 E CARSON ST
LONG BEACH CA
90807-2912
US

IV. Provider business mailing address

200 N SWALL DR UNIT 504
BEVERLY HILLS CA
90211-4725
US

V. Phone/Fax

Practice location:
  • Phone: 562-585-3636
  • Fax:
Mailing address:
  • Phone: 310-666-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NEDJAT-HAIEM
Title or Position: CEO
Credential: DDS, M.DENT.SC.
Phone: 310-666-9024