Healthcare Provider Details

I. General information

NPI: 1457886251
Provider Name (Legal Business Name): ARAS MORTAZAVI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2017
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W MAIN ST
HEBRON OH
43025-9033
US

IV. Provider business mailing address

6254 MUIRLOCH CT S
DUBLIN OH
43017-8794
US

V. Phone/Fax

Practice location:
  • Phone: 740-928-4596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: