Provider Demographics
NPI:1477663250
Name:ALEMZADEH, REZA
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:ALEMZADEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8294 HIGHWAY 92
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-3672
Mailing Address - Country:US
Mailing Address - Phone:770-928-2376
Mailing Address - Fax:770-928-3594
Practice Address - Street 1:8294 HIGHWAY 92
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-3672
Practice Address - Country:US
Practice Address - Phone:770-928-2376
Practice Address - Fax:770-928-3594
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist