Individual
DR. JUSTIN NASSIRI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
650 W BALTIMORE ST, BALTIMORE, MD 21201-1510
(310) 626-3631
Mailing address
4579 W OAK PARK DR, FRESNO, CA 93722-3248
(310) 626-3631
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
102517
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97463400G96047
—
CA
Enumeration date
06/14/2017
Last updated
08/19/2022
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