Provider Demographics
NPI:1245257898
Name:BEZREH, HUSAM MOHAMAD (DMD)
Entity type:Individual
Prefix:DR
First Name:HUSAM
Middle Name:MOHAMAD
Last Name:BEZREH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:MOHAMAD
Other - Middle Name:HUSAM
Other - Last Name:ALBZREH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:100 GALLERIA PKWY SE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-8127
Mailing Address - Country:US
Mailing Address - Phone:678-236-0500
Mailing Address - Fax:678-236-0586
Practice Address - Street 1:100 GALLERIA PKWY SE STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-8127
Practice Address - Country:US
Practice Address - Phone:678-236-0500
Practice Address - Fax:678-236-0586
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics