Provider Demographics
NPI:1215338538
Name:DIANATYAZDI & NADI PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:DIANATYAZDI & NADI PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:NADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-772-7082
Mailing Address - Street 1:77564 COUNTRY CLUB DR
Mailing Address - Street 2:STE 350
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77564 COUNTRY CLUB DR
Practice Address - Street 2:STE 350
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0484
Practice Address - Country:US
Practice Address - Phone:760-772-7082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty