Provider Demographics
NPI:1588779144
Name:SAFFARI-NAZARI, ABDOLREZA (DDS)
Entity type:Individual
Prefix:DR
First Name:ABDOLREZA
Middle Name:
Last Name:SAFFARI-NAZARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11540 HAWTHORNE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2367
Mailing Address - Country:US
Mailing Address - Phone:818-913-3158
Mailing Address - Fax:424-269-0412
Practice Address - Street 1:11540 HAWTHORNE BLVD STE B
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2367
Practice Address - Country:US
Practice Address - Phone:818-913-3158
Practice Address - Fax:424-269-0412
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-5166763OtherTAX IDENTIFICATION NUMBER