Provider Demographics
NPI:1114936523
Name:MALEKZADEH, REZA (DDS)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:MALEKZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-423-0800
Mailing Address - Fax:562-423-7766
Practice Address - Street 1:4300 LONG BEACH BLVD
Practice Address - Street 2:SUITE 415
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-423-0800
Practice Address - Fax:562-423-7766
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics