Individual
SEYED HESHMAT MORTAZAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
516 E. NIZHONI BLVD, GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1565
Mailing address
PO BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(505) 722-1565
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2342
NM
122300000X
Dentist
DE00007118
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000A9888
—
NM
05
—
586084
—
AZ
Enumeration date
06/27/2006
Last updated
04/11/2008
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