MEDICARE: MASSOUD MAXWELL HEJAZI D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4305	NV

General Provider Information

NPI Number	:	1003846544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASSOUD MAXWELL HEJAZI D.M.D.

Provider Business Mailing Address
First Line	:	6835 W TROPICANA AVE
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118
Country	:	US
Telephone Number	:	702-804-0153
Fax Number	:	702-804-0154

Provider Business Practice Location Address
First Line	:	6835 W TROPICANA AVE
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118
Country	:	US
Telephone Number	:	702-804-0153
Fax Number	:	702-804-0154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/11/2008

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