Provider Demographics
NPI:1023646791
Name:MAXWELL M NAZARI DDS INC
Entity type:Organization
Organization Name:MAXWELL M NAZARI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-528-3594
Mailing Address - Street 1:355 S LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2737
Mailing Address - Country:US
Mailing Address - Phone:909-528-3594
Mailing Address - Fax:
Practice Address - Street 1:355 S LEMON AVE
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2737
Practice Address - Country:US
Practice Address - Phone:909-528-3594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty