Provider Demographics
NPI:1710064951
Name:ZARRINNEGAR, MIKE MOHAMMADREZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:MOHAMMADREZA
Last Name:ZARRINNEGAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MOHAMMADREZA
Other - Middle Name:
Other - Last Name:ZARRINNEGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1231 WEBSTER AVE
Mailing Address - Street 2:BRONX
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3373
Mailing Address - Country:US
Mailing Address - Phone:646-402-8989
Mailing Address - Fax:646-402-8988
Practice Address - Street 1:1231 WEBSTER AVE
Practice Address - Street 2:BRONX
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3373
Practice Address - Country:US
Practice Address - Phone:646-402-8989
Practice Address - Fax:646-402-8988
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050350122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02413550Medicaid