Provider Demographics
NPI:1679630594
Name:TABRIZI, HAMID REZA (DMD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:REZA
Last Name:TABRIZI
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 1:145 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6936
Mailing Address - Country:US
Mailing Address - Phone:781-397-9400
Mailing Address - Fax:781-397-9402
Practice Address - Street 1:155 MAIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6936
Practice Address - Country:US
Practice Address - Phone:781-397-9400
Practice Address - Fax:781-397-9402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice