NPI 1104741149 · live from the CMS NPI Registry
Nima Ghorbani Moghaddam
Dentist, General Practice in Lexington, SC. National Provider Identifier 1104741149, active.
NPI record
| NPI | 1104741149 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 203 N Lake Dr, Lexington, SC 29072 |
| Practice phone | 803-520-3110 |
| Mailing address | 5800 Highlands Plaza Dr Apt 521, Saint Louis, MO 63110 |
| Enumerated | August 11, 2026 |
| Last updated | September 1, 2026 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Orthodontics and Dentofacial Orthopedics | 1223X0400X | 11559 (SC) |
| Dentist, General Practice primary | 1223G0001X | 11559 (SC) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.