Healthcare Provider Details

I. General information

NPI: 1396254991
Provider Name (Legal Business Name): NAHIDEH SHOJAEI DDS , PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E ALMOND AVE STE 103
MADERA CA
93637-5750
US

IV. Provider business mailing address

475 E ALMOND AVE STE 103
MADERA CA
93637-5750
US

V. Phone/Fax

Practice location:
  • Phone: 559-662-1010
  • Fax: 559-662-0942
Mailing address:
  • Phone: 559-662-1010
  • Fax: 559-662-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59804
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number59804
License Number StateCA

VIII. Authorized Official

Name: DR. NAHIDEH SHOJAEI
Title or Position: PRESIDENT
Credential: DDS
Phone: 559-662-1010