Provider Demographics
NPI:1750011342
Name:HOSEINZADEH, POOYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:POOYA
Middle Name:
Last Name:HOSEINZADEH
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 1:770 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2356
Mailing Address - Country:US
Mailing Address - Phone:678-557-7176
Mailing Address - Fax:
Practice Address - Street 1:800 MANSELL RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1797
Practice Address - Country:US
Practice Address - Phone:770-642-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1227041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice