Provider Demographics
NPI:1679587927
Name:KAZEMIAN, MOHAMMAD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:A
Last Name:KAZEMIAN
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 1:1414 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5160
Mailing Address - Country:US
Mailing Address - Phone:704-289-5233
Mailing Address - Fax:704-289-2009
Practice Address - Street 1:1414 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5160
Practice Address - Country:US
Practice Address - Phone:704-289-5233
Practice Address - Fax:704-289-2009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994776Medicaid
NC94776OtherBCBS