Provider Demographics
NPI:1851325062
Name:KARBASSI, ALIREZA (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:KARBASSI
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 CLINTON LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1961
Mailing Address - Country:US
Mailing Address - Phone:440-461-1675
Mailing Address - Fax:
Practice Address - Street 1:3705 MEDINA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9671
Practice Address - Country:US
Practice Address - Phone:330-723-4800
Practice Address - Fax:330-723-0988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30178021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311519933OtherTAX ID NUMBER