Provider Demographics
NPI:1528461191
Name:NADEEM U HASEEB, DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NADEEM U HASEEB, DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADEM
Authorized Official - Middle Name:U
Authorized Official - Last Name:HASEEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-336-1974
Mailing Address - Street 1:1722 SWEETWATER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7646
Mailing Address - Country:US
Mailing Address - Phone:619-336-1974
Mailing Address - Fax:619-336-1976
Practice Address - Street 1:1722 SWEETWATER RD
Practice Address - Street 2:SUITE C
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7646
Practice Address - Country:US
Practice Address - Phone:619-336-1974
Practice Address - Fax:619-336-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty