Provider Demographics
NPI:1710546056
Name:REIHANI, GOLNAZ
Entity Type:Individual
Prefix:
First Name:GOLNAZ
Middle Name:
Last Name:REIHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 STATE ROAD 70 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9734
Mailing Address - Country:US
Mailing Address - Phone:941-257-0516
Mailing Address - Fax:
Practice Address - Street 1:6250 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9734
Practice Address - Country:US
Practice Address - Phone:941-257-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist