Provider Demographics
NPI:1356441224
Name:RAZEGHI, NEZHAT (DDS)
Entity Type:Individual
Prefix:MRS
First Name:NEZHAT
Middle Name:
Last Name:RAZEGHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4802
Mailing Address - Country:US
Mailing Address - Phone:201-683-2424
Mailing Address - Fax:201-654-0752
Practice Address - Street 1:714 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4802
Practice Address - Country:US
Practice Address - Phone:201-683-2424
Practice Address - Fax:201-654-0752
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2201017152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0028401Medicaid