Organization Name: | CALIFORNIA DENTAL CARE, NAHREEN IMAM, DDS, INC. |
NPI Number: | 1306035597 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NAHREEN IMAM (PRESIDENT) |
Mailing Address: | 3860 Broadway St Suite # 104 American Canyon |
State: | CA US |
Postal Code: | 945034256 |
Phone Number: | 5102336611 |
Fax Number: | |
NPI Enumeration Date: | 10/24/2007 |
NPI Last Update Date: | 10/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 54000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |