Healthcare Provider Details

I. General information

NPI: 1992894919
Provider Name (Legal Business Name): NADER DAYANI D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD 802
LOS ANGELES CA
90025-1708
US

IV. Provider business mailing address

11645 WILSHIRE BLVD 802
LOS ANGELES CA
90025-1708
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-7494
  • Fax: 310-826-9564
Mailing address:
  • Phone: 310-826-7494
  • Fax: 310-826-9564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number32444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: