Provider Demographics
NPI:1215602479
Name:REZAYEE, MANIZHA (DMD)
Entity Type:Individual
Prefix:
First Name:MANIZHA
Middle Name:
Last Name:REZAYEE
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 1:9488 SE GRACE CIR
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-5009
Mailing Address - Country:US
Mailing Address - Phone:503-405-2236
Mailing Address - Fax:
Practice Address - Street 1:5520 N INTERSTATE AVE # UNITS12
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4526
Practice Address - Country:US
Practice Address - Phone:503-734-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist