Healthcare Provider Details

I. General information

NPI: 1902629090
Provider Name (Legal Business Name): M. NEDJAT-HAIEM DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 TOWN CENTER DR
OXNARD CA
93036-1168
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NEDJAT-HAIEM
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-666-9024