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General NPI Number Information
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NPI Number | 1558723122
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Entity Type | Organization
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Legal Business Name | NAZ DENTAL CORPORATION
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 2948 HILLTOP MALL RD
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City | SAN PABLO
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State | CA
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Zip | 94806-1902
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Country | US
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Telephone | 510-223-5676
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Fax | 510-223-8719
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Provider Business Mailing Address
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Address Line | 2948 HILLTOP MALL RD
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City | SAN PABLO
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State | CA
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Zip | 94806-1902
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Country | US
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Telephone | 510-223-5676
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Fax | 510-223-8719
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Authorized Official
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Title or Position | PRESIDENT
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Name | OMERA NAZ
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Credential |
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Telephone | 510-223-5676
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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 | 52139
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License Number State | CA
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