Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 35770 | TX |
NPI | 1003459355 |
---|---|
Provider Name | Naser Mohammadzadeh Rezaei |
First Address | Saint James, NY 11780-1357 |
Second Address | El Paso, TX 79912-5572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2019 |
Last Update Date | 18/10/2019 |