Provider Demographics
NPI:1376696567
Name:NAMJOO, ALIREZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:NAMJOO
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 1:100 RICHARDS AVE
Mailing Address - Street 2:APT. 301
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1629
Mailing Address - Country:US
Mailing Address - Phone:646-325-7110
Mailing Address - Fax:
Practice Address - Street 1:1761 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5752
Practice Address - Country:US
Practice Address - Phone:203-375-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT95551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice