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General NPI Number Information
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NPI Number | 1154146850
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Entity Type | Organization
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Legal Business Name | SINA NIA, DMD, INC.
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 12810 HEACOCK ST STE B103
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City | MORENO VALLEY
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State | CA
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Zip | 92553-3171
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Country | US
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Telephone | 951-242-3441
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Fax | 949-289-9218
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Provider Business Mailing Address
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Address Line | 12810 HEACOCK ST STE B103
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City | MORENO VALLEY
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State | CA
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Zip | 92553-3171
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Country | US
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Telephone | 951-242-3441
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SINA NIA
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Credential |
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Telephone | 408-355-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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