MEDICARE: NADEEM U HASEEB, DDS A PROFESSIONAL CORPORATION

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	52294	CA

General Provider Information

NPI Number	:	1528461191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NADEEM U HASEEB, DDS A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1722 SWEETWATER RD
Second Line	:	SUITE C
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-7646
Country	:	US
Telephone Number	:	619-336-1974
Fax Number	:	619-336-1976

Provider Business Practice Location Address
First Line	:	1722 SWEETWATER RD
Second Line	:	SUITE C
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-7646
Country	:	US
Telephone Number	:	619-336-1974
Fax Number	:	619-336-1976

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	NADEM U HASEEB
Credential	:
Telephone Number	:	619-336-1974

Provider Enumeration Date	:	09/26/2014
Last Update Date	:	09/26/2014

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