Provider Demographics
NPI:1386856987
Name:KAZEMI, REZA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:B
Last Name:KAZEMI
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 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:UNIVERSITY DENTISTS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2820
Mailing Address - Country:US
Mailing Address - Phone:860-679-3170
Mailing Address - Fax:860-679-8162
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:UNIVERSITY DENTISTS
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2820
Practice Address - Country:US
Practice Address - Phone:860-679-3170
Practice Address - Fax:860-679-8162
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice