Provider Demographics
NPI:1467609719
Name:NOROOZI, AHMAD-REZA (DDS)
Entity Type:Individual
Prefix:
First Name:AHMAD-REZA
Middle Name:
Last Name:NOROOZI
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 1:5417 GATEWAY CTR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3980
Mailing Address - Country:US
Mailing Address - Phone:810-424-0705
Mailing Address - Fax:
Practice Address - Street 1:306 N GOULD ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2417
Practice Address - Country:US
Practice Address - Phone:989-723-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010199371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery