MEDICARE: DR. KAMYAR ALIZADEGAN DMD

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	122300000X	Dentist	27034	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720725971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMYAR ALIZADEGAN DMD

Provider Business Mailing Address
First Line	:	31 SE 5TH ST APT 2511
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-2518
Country	:	US
Telephone Number	:	561-410-3874
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 N MIAMI BEACH BLVD
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3701
Country	:	US
Telephone Number	:	305-907-2186
Fax Number	:

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	06/11/2022

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