Provider Demographics
NPI:1033275029
Name:REZAI, NESHAT (DDS)
Entity Type:Individual
Prefix:
First Name:NESHAT
Middle Name:
Last Name:REZAI
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 1:2844 SUMMIT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3642
Mailing Address - Country:US
Mailing Address - Phone:510-296-8080
Mailing Address - Fax:
Practice Address - Street 1:2844 SUMMIT ST STE 203
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3642
Practice Address - Country:US
Practice Address - Phone:510-296-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist