Provider Demographics
NPI:1861139719
Name:NIKJOO DDS INC.
Entity type:Organization
Organization Name:NIKJOO DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EBI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKJOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-820-5062
Mailing Address - Street 1:941 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4740
Mailing Address - Country:US
Mailing Address - Phone:909-820-5062
Mailing Address - Fax:
Practice Address - Street 1:941 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4740
Practice Address - Country:US
Practice Address - Phone:909-820-5062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental