Individual
DR. REZA HAKIM SHOUSHTARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
240 S 40TH ST, PHILADELPHIA, PA 19104-6030
(484) 886-6288
Mailing address
240 S 40TH ST, PHILADELPHIA, PA 19104-6030
(484) 886-6288
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS040929
PA
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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