Provider Demographics
NPI:1003028440
Name:ASSADZADEH, MOHAMMADREZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMADREZA
Middle Name:
Last Name:ASSADZADEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:REZA
Other - Middle Name:
Other - Last Name:ASSAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:181 CHAPS LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6174
Mailing Address - Country:US
Mailing Address - Phone:610-455-1490
Mailing Address - Fax:
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1743
Practice Address - Country:US
Practice Address - Phone:610-640-9500
Practice Address - Fax:610-640-4700
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029820-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice