1245379114 NPI number — DR. MIR JAMSHED NASIM DMD

Table of content: DR. MIR JAMSHED NASIM DMD (NPI 1245379114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245379114 NPI number — DR. MIR JAMSHED NASIM DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NASIM
Provider First Name:
MIR
Provider Middle Name:
JAMSHED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NASIM
Provider Other First Name:
JIM
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245379114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 BURTON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-576-7169
Provider Business Mailing Address Fax Number:
864-576-7996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 BURTON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-576-7169
Provider Business Practice Location Address Fax Number:
864-576-7996
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2881 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZX2881 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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