Provider Demographics
NPI:1821430588
Name:R MALEKZADEH, D.D.S., INC.
Entity Type:Organization
Organization Name:R MALEKZADEH, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEKZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-804-5383
Mailing Address - Street 1:5722 TELEPHONE RD
Mailing Address - Street 2:SUITE#4
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5318
Mailing Address - Country:US
Mailing Address - Phone:805-804-5383
Mailing Address - Fax:
Practice Address - Street 1:5722 TELEPHONE RD
Practice Address - Street 2:SUITE#4
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5318
Practice Address - Country:US
Practice Address - Phone:805-804-5383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty