MEDICARE: DR. SEYED-MAHMOUDREZA MODARESZADEH-ESFAHANI DDS, MSD

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	1223E0200X	Endodontics	2583	OH

General Provider Information

NPI Number	:	1104074491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEYED-MAHMOUDREZA MODARESZADEH-ESFAHANI DDS, MSD

Provider Business Mailing Address
First Line	:	27060 CEDAR ROAD, APT. PH1
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122
Country	:	US
Telephone Number	:	216-591-1293
Fax Number	:

Provider Business Practice Location Address
First Line	:	10900 EUCLID AVE.,
Second Line	:	CASE WESTERN RESERVE UNIVERSITY, DENTAL SCHOOL
City	:	CLEVELAND
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:	216-368-6798
Fax Number	:

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

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	08/29/2008

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