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General NPI Number Information
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NPI Number | 1336683549
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Entity Type | Organization
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Legal Business Name | AVISHAN K. NASIRI, DMD, INC.
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 801 N TUSTIN AVE STE 504
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City | SANTA ANA
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State | CA
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Zip | 92705-3609
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Country | US
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Telephone | 714-550-0500
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Fax | 714-550-9560
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Provider Business Mailing Address
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Address Line | 801 N TUSTIN AVE STE 504
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City | SANTA ANA
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State | CA
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Zip | 92705-3609
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Country | US
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Telephone | 714-550-0500
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Fax | 714-550-9560
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. AVISHAN K. NASIRI
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Credential | DMD
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Telephone | 949-981-5601
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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 | 64535
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License Number State | CA
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