Provider Demographics
NPI:1689922080
Name:HAMIDZADEH, ALIREZA (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:HAMIDZADEH
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13418 BISSEL LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1016
Mailing Address - Country:US
Mailing Address - Phone:301-750-7000
Mailing Address - Fax:
Practice Address - Street 1:1896 URBANA PIKE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-8548
Practice Address - Country:US
Practice Address - Phone:301-750-7000
Practice Address - Fax:301-476-1133
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413736122300000X
MD15831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist