Healthcare Provider Details

I. General information

NPI: 1467014910
Provider Name (Legal Business Name): HAMID R. NADI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W BEVERLY BLVD
MONTEBELLO CA
90640-1536
US

IV. Provider business mailing address

3301 W BEVERLY BLVD
MONTEBELLO CA
90640-1536
US

V. Phone/Fax

Practice location:
  • Phone: 323-722-6766
  • Fax: 323-722-2022
Mailing address:
  • Phone: 323-722-6766
  • Fax: 323-722-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: HAMID R NADI
Title or Position: OWNER
Credential: DDS
Phone: 323-722-6766