Healthcare Provider Details

I. General information

NPI: 1386553121
Provider Name (Legal Business Name): NADER M. VAFAIE DMD MMSC PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 HILL RD STE 19
NOVATO CA
94947-4304
US

IV. Provider business mailing address

1615 HILL RD STE 19
NOVATO CA
94947-4304
US

V. Phone/Fax

Practice location:
  • Phone: 415-209-6000
  • Fax: 415-209-6100
Mailing address:
  • Phone: 415-209-6000
  • Fax: 415-209-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAELA MUNIZ
Title or Position: VP, PAYOR RELATIONS
Credential:
Phone: 469-324-3242