Individual
AMIR MOSTATABZADEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2119 W BRANDON BLVD STE F, BRANDON, FL 33511-4731
(239) 405-5592
Mailing address
2119 W BRANDON BLVD STE F, BRANDON, FL 33511-4731
(239) 405-5592
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22889
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2017
Last updated
06/29/2019
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