Provider Demographics
NPI:1306035597
Name:CALIFORNIA DENTAL CARE, NAHREEN IMAM, DDS, INC.
Entity type:Organization
Organization Name:CALIFORNIA DENTAL CARE, NAHREEN IMAM, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAHREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-233-6611
Mailing Address - Street 1:5223 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2154
Mailing Address - Country:US
Mailing Address - Phone:510-233-6611
Mailing Address - Fax:
Practice Address - Street 1:3860 BROADWAY ST
Practice Address - Street 2:SUITE # 104
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-4256
Practice Address - Country:US
Practice Address - Phone:510-233-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental