Provider Demographics
NPI:1730327537
Name:DIBA, NAZLI (DDS)
Entity type:Individual
Prefix:
First Name:NAZLI
Middle Name:
Last Name:DIBA
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 1:27 BAKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1435
Mailing Address - Country:US
Mailing Address - Phone:516-570-2937
Mailing Address - Fax:
Practice Address - Street 1:5121 108TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3304
Practice Address - Country:US
Practice Address - Phone:718-699-9500
Practice Address - Fax:718-699-9021
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050363-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry