Individual
REZA HADIOONZADEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4919 OUTER LOOP, LOUISVILLE, KY 40219-4051
(518) 421-2627
Mailing address
3039 32ND ST APT 2B, ASTORIA, NY 11102-2083
(518) 421-2627
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
11076
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12976
TN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
11076
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
12976
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/15/2019
Last updated
04/21/2026
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