Provider Demographics
NPI:1851887533
Name:REZAEI, GHAZALEH (DMD)
Entity Type:Individual
Prefix:
First Name:GHAZALEH
Middle Name:
Last Name:REZAEI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 W ARBY AVE UNIT 326
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4659
Mailing Address - Country:US
Mailing Address - Phone:023-323-1557
Mailing Address - Fax:
Practice Address - Street 1:7181 N HUALAPAI WAY STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-1118
Practice Address - Country:US
Practice Address - Phone:702-852-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist