Individual
NASTARAN MOSHAEINEZHAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1209 N RETAIL CT, MYRTLE BEACH, SC 29577-9626
(843) 357-0213
Mailing address
845 BLUFFVIEW DR, MYRTLE BEACH, SC 29579-5268
(718) 808-3942
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.10596
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2023
Last updated
07/17/2023
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