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General NPI Number Information
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NPI Number | 1043929185
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Entity Type | Individual
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Provider Name | NATHAN NISSANI DDS
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Gender | Male
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 864 N HACIENDA BLVD
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City | LA PUENTE
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State | CA
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Zip | 91744-2847
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Country | US
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Telephone | 310-720-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 CENTURY PARK E
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City | LOS ANGELES
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State | CA
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Zip | 90067-2244
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Country | US
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Telephone | 310-278-5147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 107387
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License Number State | CA
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