Provider Demographics
NPI:1427577881
Name:ALAVI, REZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:ALAVI
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:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-0393
Mailing Address - Country:US
Mailing Address - Phone:214-440-7950
Mailing Address - Fax:
Practice Address - Street 1:1501 HALL JOHNSON RD UNIT 393
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-2316
Practice Address - Country:US
Practice Address - Phone:214-440-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty