Provider Demographics
NPI:1477445161
Name:ABDEHOO, NAZANIN
Entity type:Individual
Prefix:
First Name:NAZANIN
Middle Name:
Last Name:ABDEHOO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7626 WINDBRIDGE DR APT 51
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4955
Mailing Address - Country:US
Mailing Address - Phone:318-470-8970
Mailing Address - Fax:
Practice Address - Street 1:3290 ARENA BLVD STE 610
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3003
Practice Address - Country:US
Practice Address - Phone:916-574-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1119601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice