MEDICARE: SEYED ALIREZA REZAEI 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	1223G0001X	General Practice Dentistry	9828	CO
2	1223G0001X	General Practice Dentistry	5998	NV

General Provider Information

NPI Number	:	1568600328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEYED ALIREZA REZAEI DDS

Provider Business Mailing Address
First Line	:	3315 W CRAIG RD
Second Line	:	#108
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-5000
Country	:	US
Telephone Number	:	702-202-2970
Fax Number	:

Provider Business Practice Location Address
First Line	:	3315 W CRAIG RD
Second Line	:	#108
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-5000
Country	:	US
Telephone Number	:	702-202-2970
Fax Number	:

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

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	03/29/2014

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