Provider Demographics
NPI:1659430627
Name:HEKMAT, REZA (DMD INC)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:HEKMAT
Suffix:
Gender:M
Credentials:DMD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16959 BERNARDO CENTER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2553
Mailing Address - Country:US
Mailing Address - Phone:858-485-5925
Mailing Address - Fax:858-485-9068
Practice Address - Street 1:16959 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2553
Practice Address - Country:US
Practice Address - Phone:858-485-5925
Practice Address - Fax:858-485-9068
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice