Healthcare Provider Details

I. General information

NPI: 1720725971
Provider Name (Legal Business Name): KAMYAR ALIZADEGAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 06/11/2022
Certification Date: 06/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 N MIAMI BEACH BLVD
NORTH MIAMI BEACH FL
33162-3701
US

IV. Provider business mailing address

31 SE 5TH ST APT 2511
MIAMI FL
33131-2518
US

V. Phone/Fax

Practice location:
  • Phone: 305-907-2186
  • Fax:
Mailing address:
  • Phone: 561-410-3874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number27034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: