Individual
MR. MEHRAN HOSSAINIZADEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3223 N. BROAD STREET, PHILADELPHIA, PA 19140
(215) 707-7756
(215) 707-5885
Mailing address
PO BOX 824635, PHILADELPHIA, PA 19182-4635
(215) 707-2912
(215) 707-5885
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
53369
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DA030545R
PA
Other
Enumeration date
04/26/2006
Last updated
12/15/2021
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