Provider Demographics
NPI:1942678495
Name:GHAZISHARIF, NAZANIN (DDS)
Entity type:Individual
Prefix:DR
First Name:NAZANIN
Middle Name:
Last Name:GHAZISHARIF
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 1:2625 NASHVILLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4098
Mailing Address - Country:US
Mailing Address - Phone:615-476-2317
Mailing Address - Fax:
Practice Address - Street 1:2625 NASHVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4098
Practice Address - Country:US
Practice Address - Phone:615-476-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice