Provider Demographics
NPI:1871688929
Name:MOHAMMADIZADEH, HOSSEIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:MOHAMMADIZADEH
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 1:3975 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4467
Mailing Address - Country:US
Mailing Address - Phone:770-619-0014
Mailing Address - Fax:770-619-0079
Practice Address - Street 1:3975 OLD MILTON PKWY
Practice Address - Street 2:SUITE 3
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4467
Practice Address - Country:US
Practice Address - Phone:770-619-0014
Practice Address - Fax:770-619-0079
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA123271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice