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General NPI Number Information
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NPI Number | 1336359405
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Entity Type | Individual
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Provider Name | TANDIS NAMVAR NAMI DDS
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4955 VAN NUYS BLVD STE 716
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1843
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Country | US
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Telephone | 818-784-6145
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 WELLESLEY AVE APT 303
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City | LOS ANGELES
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State | CA
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Zip | 90025-1171
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Country | US
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Telephone | 310-562-0939
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50165
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License Number State | CA
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