Provider Demographics
NPI:1891412250
Name:NAWAZ, ISMAEL SIKANDER (DDS)
Entity type:Individual
Prefix:
First Name:ISMAEL
Middle Name:SIKANDER
Last Name:NAWAZ
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 1:1155 S GRAND AVE APT 1217
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2789
Mailing Address - Country:US
Mailing Address - Phone:909-263-0770
Mailing Address - Fax:
Practice Address - Street 1:1643 S SAN JACINTO AVE STE 100&101
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5181
Practice Address - Country:US
Practice Address - Phone:951-654-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist