Provider Demographics
NPI:1720725971
Name:ALIZADEGAN, KAMYAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAMYAR
Middle Name:
Last Name:ALIZADEGAN
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 1:31 SE 5TH ST APT 2511
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2518
Mailing Address - Country:US
Mailing Address - Phone:561-410-3874
Mailing Address - Fax:
Practice Address - Street 1:880 N MIAMI BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3701
Practice Address - Country:US
Practice Address - Phone:305-907-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist