MEDICARE: DR. NARDIN ASHKAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D12178	MN

General Provider Information

NPI Number	:	1134353519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NARDIN ASHKAN

Provider Business Mailing Address
First Line	:	7532 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3101
Country	:	US
Telephone Number	:	735-560-1555
Fax Number	:

Provider Business Practice Location Address
First Line	:	7532 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3101
Country	:	US
Telephone Number	:	735-560-1555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	05/13/2009

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