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General NPI Number Information
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NPI Number | 1508650995
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Entity Type | Organization
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Legal Business Name | GHARAVIZADEH PC 2
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 328 W CARSON BLVD STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28203-4072
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Country | US
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Telephone | 704-910-5006
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Fax |
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Provider Business Mailing Address
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Address Line | 501 HOLLIS RD
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City | CHARLOTTE
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State | NC
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Zip | 28209-1942
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Country | US
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Telephone | 704-345-5390
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PEYMAN GHARAVIZADEH
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Credential | DDS
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Telephone | 704-345-5390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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