Provider Demographics
NPI:1336359405
Name:NAMVAR NAMI, TANDIS (DDS)
Entity type:Individual
Prefix:DR
First Name:TANDIS
Middle Name:
Last Name:NAMVAR NAMI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 WELLESLEY AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1171
Mailing Address - Country:US
Mailing Address - Phone:310-562-0939
Mailing Address - Fax:
Practice Address - Street 1:4955 VAN NUYS BLVD STE 716
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1843
Practice Address - Country:US
Practice Address - Phone:818-784-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice