MEDICARE: MARIAM NADI DDS

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	52650	CA

General Provider Information

NPI Number	:	1609071216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM NADI DDS

Provider Business Mailing Address
First Line	:	3614 W ESTATES LN UNIT A
Second Line	:
City	:	PALOS VERDES
State	:	CA
Zip	:	90274
Country	:	US
Telephone Number	:	310-539-1111
Fax Number	:	310-539-4111

Provider Business Practice Location Address
First Line	:	3614 W ESTATES LN UNIT A
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-4148
Country	:	US
Telephone Number	:	310-539-1111
Fax Number	:	310-539-4111

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	07/08/2007

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