Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2583 | OH |
NPI | 1104074491 |
---|---|
Provider Name | Dr. Seyed-Mahmoudreza Modareszadeh-Esfahani |
First Address | Beachwood, OH 44122 |
Second Address | Cleveland, OH 44106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2008 |
Last Update Date | 29/08/2008 |