Provider Demographics
NPI:1750358859
Name:AHMADI, AHMADREZA (DDS)
Entity type:Individual
Prefix:
First Name:AHMADREZA
Middle Name:
Last Name:AHMADI
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 1:1538 BANTRY CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-6022
Mailing Address - Country:US
Mailing Address - Phone:530-243-3450
Mailing Address - Fax:
Practice Address - Street 1:1667 HILLTOP DR
Practice Address - Street 2:ACCESS DENTAL
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0251
Practice Address - Country:US
Practice Address - Phone:530-223-5500
Practice Address - Fax:530-223-1817
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist