Healthcare Provider Details

I. General information

NPI: 1427272475
Provider Name (Legal Business Name): FEREIDOON REZVANI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 EYE STREET NW SUITE 600
WASHINGTON DC
20006
US

IV. Provider business mailing address

1712 EYE STREET NW SUITE 600
WASHINGTON DC
20006
US

V. Phone/Fax

Practice location:
  • Phone: 202-331-0655
  • Fax: 202-331-8558
Mailing address:
  • Phone: 202-331-0655
  • Fax: 202-331-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00004380
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: