Provider Demographics
NPI:1134429319
Name:ALI BEHZADI D.M.D P.A
Entity type:Organization
Organization Name:ALI BEHZADI D.M.D P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHZADI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-831-4077
Mailing Address - Street 1:945 STATE ROAD 436
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5662
Mailing Address - Country:US
Mailing Address - Phone:407-831-4077
Mailing Address - Fax:407-831-8077
Practice Address - Street 1:945 STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5662
Practice Address - Country:US
Practice Address - Phone:407-831-4077
Practice Address - Fax:407-831-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental