MEDICARE: DR. NAZANIN GHOBADI DDS, FAGD

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	1223G0001X	General Practice Dentistry	DS028484L	PA

General Provider Information

NPI Number	:	1447305149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAZANIN GHOBADI DDS, FAGD

Provider Business Mailing Address
First Line	:	2 PENN BLVD STE 216
Second Line	:	GERMANTOWN COMMUNITY HEALTHCARE SERVICES
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1403
Country	:	US
Telephone Number	:	215-951-8900
Fax Number	:	215-951-8965

Provider Business Practice Location Address
First Line	:	2 PENN BLVD STE 216
Second Line	:	GERMANTOWN COMMUNITY HEALTHCARE SERVICES
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1403
Country	:	US
Telephone Number	:	215-951-8900
Fax Number	:	215-951-8965

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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