Provider Demographics
NPI:1871784918
Name:NADERSHAHI, NADER A (DDS)
Entity type:Individual
Prefix:DR
First Name:NADER
Middle Name:A
Last Name:NADERSHAHI
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 1:122 TUNSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2622
Mailing Address - Country:US
Mailing Address - Phone:415-459-0114
Mailing Address - Fax:415-459-2717
Practice Address - Street 1:122 TUNSTEAD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2622
Practice Address - Country:US
Practice Address - Phone:415-459-0114
Practice Address - Fax:415-459-2717
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice