Provider Demographics
NPI:1205239514
Name:HOSSEINI, ARASH REZA (DDS)
Entity type:Individual
Prefix:DR
First Name:ARASH
Middle Name:REZA
Last Name:HOSSEINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W ADDISON ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6026
Mailing Address - Country:US
Mailing Address - Phone:847-445-8212
Mailing Address - Fax:
Practice Address - Street 1:495 N RIVERSIDE DR
Practice Address - Street 2:#211
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5908
Practice Address - Country:US
Practice Address - Phone:847-445-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0298341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice