MEDICARE: DR. ARAS MORTAZAVI DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	30.025052	OH

General Provider Information

NPI Number	:	1457886251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARAS MORTAZAVI DDS

Provider Business Mailing Address
First Line	:	6254 MUIRLOCH CT S
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-8794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 W MAIN ST
Second Line	:
City	:	HEBRON
State	:	OH
Zip	:	43025-9033
Country	:	US
Telephone Number	:	740-928-4596
Fax Number	:

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

Provider Enumeration Date	:	04/29/2017
Last Update Date	:	01/19/2022

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