Provider Demographics
NPI:1518286731
Name:BEHESHTI, REZA (DDS)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:BEHESHTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SEYED MAHMOUDREZA
Other - Middle Name:
Other - Last Name:BEHESHTISHIRAZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2730 UNIVERSITY BLVD W STE 1010
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5902
Mailing Address - Country:US
Mailing Address - Phone:240-752-8822
Mailing Address - Fax:240-752-8821
Practice Address - Street 1:2730 UNIVERSITY BLVD W STE 1010
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5902
Practice Address - Country:US
Practice Address - Phone:240-752-8822
Practice Address - Fax:240-752-8821
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014134721223P0221X
MD147621223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program