Healthcare Provider Details

I. General information

NPI: 1639016181
Provider Name (Legal Business Name): AHMAD MIRAN NAWAZ DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 GARNET AVE STE 1K
SAN DIEGO CA
92109-3674
US

IV. Provider business mailing address

2180 GARNET AVE STE 1K
SAN DIEGO CA
92109-3674
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-3002
  • Fax:
Mailing address:
  • Phone: 858-264-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMAD NAWAZ
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 858-264-3002