Provider Demographics
NPI:1033207287
Name:ALLAMEHZADEH, ELLAMEH (DDS)
Entity Type:Individual
Prefix:
First Name:ELLAMEH
Middle Name:
Last Name:ALLAMEHZADEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 CAMINO DEL RIO S
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3520
Mailing Address - Country:US
Mailing Address - Phone:619-260-4990
Mailing Address - Fax:
Practice Address - Street 1:1333 CAMINO DEL RIO S
Practice Address - Street 2:#202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3520
Practice Address - Country:US
Practice Address - Phone:619-260-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist