Healthcare Provider Details

I. General information

NPI: 1952058075
Provider Name (Legal Business Name): ARIA AVRAHAM HOURIZADEH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 MERRICK AVE
MERRICK NY
11566-3463
US

IV. Provider business mailing address

26 BEVERLY RD
GREAT NECK NY
11021-1330
US

V. Phone/Fax

Practice location:
  • Phone: 516-382-6251
  • Fax:
Mailing address:
  • Phone: 516-382-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number063304
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: