Provider Demographics
NPI:1053090225
Name:NILFORUSHAN, IMAN (DDS)
Entity type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:NILFORUSHAN
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 1:760 SILVER OAK DR APT 108
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-4929
Mailing Address - Country:US
Mailing Address - Phone:949-310-8697
Mailing Address - Fax:
Practice Address - Street 1:956 TOPSY LN STE 103
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-8455
Practice Address - Country:US
Practice Address - Phone:775-391-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV78801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice