Provider Demographics
NPI:1043506041
Name:REZAIE, YEGANEH (DMD)
Entity Type:Individual
Prefix:DR
First Name:YEGANEH
Middle Name:
Last Name:REZAIE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6758
Mailing Address - Country:US
Mailing Address - Phone:614-906-0115
Mailing Address - Fax:
Practice Address - Street 1:3801 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6758
Practice Address - Country:US
Practice Address - Phone:614-906-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist