Provider Demographics
NPI:1467961680
Name:NIKOONEZHAD, DARA (DMD)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:NIKOONEZHAD
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 1:32 ELY RD
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2352
Mailing Address - Country:US
Mailing Address - Phone:732-615-8087
Mailing Address - Fax:
Practice Address - Street 1:151 GREENTREE RD STE A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9416
Practice Address - Country:US
Practice Address - Phone:856-983-9620
Practice Address - Fax:856-983-7714
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026910001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice