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General NPI Number Information
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NPI Number | 1508929753
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Entity Type | Individual
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Provider Name | REZA HESHMATI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 805 BROADWAY ST STE 110
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City | VANCOUVER
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State | WA
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Zip | 98660-3283
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Country | US
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Telephone | 360-524-7100
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Fax | 360-524-7101
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Provider Business Mailing Address
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Address Line | 305 W 12TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43210-1267
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Country | US
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Telephone | 614-292-1472
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Fax | 614-292-9422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 71-0000152
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 61262027
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License Number State | WA
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