Provider Demographics
NPI:1053529586
Name:NIKNAM & KHANIAN DENTAL PRACTICE, INC.
Entity type:Organization
Organization Name:NIKNAM & KHANIAN DENTAL PRACTICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:JOLICOEUR
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:661-722-7722
Mailing Address - Street 1:4023 W AVENUE L
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4213
Mailing Address - Country:US
Mailing Address - Phone:661-722-7722
Mailing Address - Fax:661-722-7726
Practice Address - Street 1:4023 W AVENUE L
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4213
Practice Address - Country:US
Practice Address - Phone:661-722-7722
Practice Address - Fax:661-722-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty