Provider Demographics
NPI:1750043139
Name:DR DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:DR DENTAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YEGANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:614-906-0115
Mailing Address - Street 1:7737 N UNIVERSITY DR STE 207-209
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2961
Mailing Address - Country:US
Mailing Address - Phone:954-721-2581
Mailing Address - Fax:
Practice Address - Street 1:7737 N UNIVERSITY DR STE 209
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2961
Practice Address - Country:US
Practice Address - Phone:954-721-2581
Practice Address - Fax:954-721-9067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty