Provider Demographics
NPI:1215006085
Name:NASSERY, HAMIDREZA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAMIDREZA
Middle Name:A
Last Name:NASSERY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 ARTHUR GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3413
Mailing Address - Country:US
Mailing Address - Phone:305-672-4444
Mailing Address - Fax:305-672-8997
Practice Address - Street 1:757 ARTHUR GODFREY RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3413
Practice Address - Country:US
Practice Address - Phone:305-672-4444
Practice Address - Fax:305-672-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN13372OtherLICENSE