Provider Demographics
NPI:1710359971
Name:AMIR IZADDOUST
Entity Type:Organization
Organization Name:AMIR IZADDOUST
Other - Org Name:ALL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:IZADDOUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-762-4604
Mailing Address - Street 1:723 N. FIELDER RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:76012
Mailing Address - Country:US
Mailing Address - Phone:214-762-4604
Mailing Address - Fax:
Practice Address - Street 1:723 N. FIELDER RD
Practice Address - Street 2:SUITE E
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:76012
Practice Address - Country:US
Practice Address - Phone:214-762-4604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty