Provider Demographics
NPI:1316232051
Name:RAJAEI, BEHZAD (DDS)
Entity Type:Individual
Prefix:
First Name:BEHZAD
Middle Name:
Last Name:RAJAEI
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 1:9236 SW 31ST PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7935
Mailing Address - Country:US
Mailing Address - Phone:352-872-5854
Mailing Address - Fax:
Practice Address - Street 1:7451 103RD ST
Practice Address - Street 2:SUITE 18
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9300
Practice Address - Country:US
Practice Address - Phone:904-777-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60396122300000X
FLDN20462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist