MEDICARE: DR. ANWAR Z NASSER D.D.S

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	45935	CA

General Provider Information

NPI Number	:	1356349500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANWAR Z NASSER D.D.S

Provider Business Mailing Address
First Line	:	6326B MISSION BLVD
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-4123
Country	:	US
Telephone Number	:	951-367-1666
Fax Number	:	951-367-1667

Provider Business Practice Location Address
First Line	:	6236B MISSION BLVD
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-4257
Country	:	US
Telephone Number	:	951-367-1666
Fax Number	:	951-367-1667

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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