Provider Demographics
NPI:1780004754
Name:GAMZEH, LIRON
Entity type:Individual
Prefix:
First Name:LIRON
Middle Name:
Last Name:GAMZEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEAN DR STE D
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2870
Mailing Address - Country:US
Mailing Address - Phone:443-928-5322
Mailing Address - Fax:
Practice Address - Street 1:2 DEAN DR STE D
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2870
Practice Address - Country:US
Practice Address - Phone:201-871-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02588300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist