MEDICARE: NAZ DENTAL 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	1223G0001X	General Practice Dentistry	52139	CA

General Provider Information

NPI Number	:	1558723122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAZ DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2948 HILLTOP MALL RD
Second Line	:
City	:	SAN PABLO
State	:	CA
Zip	:	94806-1902
Country	:	US
Telephone Number	:	510-223-5676
Fax Number	:	510-223-8719

Provider Business Practice Location Address
First Line	:	2948 HILLTOP MALL RD
Second Line	:
City	:	SAN PABLO
State	:	CA
Zip	:	94806-1902
Country	:	US
Telephone Number	:	510-223-5676
Fax Number	:	510-223-8719

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OMERA NAZ
Credential	:
Telephone Number	:	510-223-5676

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	03/23/2016

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Directions to “NAZ DENTAL CORPORATION ” Practice Location

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