=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225459084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMID K NAMAZI, DDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2013
-----------------------------------------------------
Last Update Date | 01/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3525 W DUBLIN GRANVILLE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43235-7900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-764-0544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3525 W DUBLIN GRANVILLE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43235-7900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-764-0544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HAMID K NAMAZI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 614-374-3550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 30-019570
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------