MEDICARE: NASIBI 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1891575635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASIBI DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	16537 BELLFLOWER BLVD STE B
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-5449
Country	:	US
Telephone Number	:	562-867-2026
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 N TUSTIN AVE STE 114
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1737
Country	:	US
Telephone Number	:	310-922-0221
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. PEJMAN NASIBI
Credential	:	DDS
Telephone Number	:	310-922-0221

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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Directions to “NASIBI DENTAL CORPORATION ” Practice Location

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