Individual
JACK KOHANZADEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
233 E SHORE RD, SUITE # 107, GREAT NECK, NY 11023-2433
(516) 482-7557
Mailing address
233 E SHORE RD, SUITE # 107, GREAT NECK, NY 11023-2433
(516) 482-7557
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
NY034044
NY
Other
Enumeration date
01/16/2008
Last updated
01/16/2008
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