Healthcare Provider Details

I. General information

NPI: 1003846544
Provider Name (Legal Business Name): MASSOUD MAXWELL HEJAZI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6835 W TROPICANA AVE SUITE 110
LAS VEGAS NV
89118
US

IV. Provider business mailing address

6835 W TROPICANA AVE SUITE 110
LAS VEGAS NV
89118
US

V. Phone/Fax

Practice location:
  • Phone: 702-804-0153
  • Fax: 702-804-0154
Mailing address:
  • Phone: 702-804-0153
  • Fax: 702-804-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4305
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: