Provider Demographics
NPI:1114164480
Name:MADJD, HAMID REZA KASHANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:REZA KASHANI
Last Name:MADJD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:HAMID
Other - Middle Name:
Other - Last Name:KASHANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3701 W NORTHWEST HIGHWAY
Mailing Address - Street 2:SUITE # 306
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220
Mailing Address - Country:US
Mailing Address - Phone:214-353-0683
Mailing Address - Fax:972-764-8760
Practice Address - Street 1:3701 W NORTHWEST HIGHWAY
Practice Address - Street 2:SUITE # 306
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220
Practice Address - Country:US
Practice Address - Phone:214-353-0683
Practice Address - Fax:972-764-8760
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24349122300000X
TX0024349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist