Individual
A REZA MIREMADI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., DDS., LLC
Contact information
Practice address
576 N MAIN ST, SPRINGBORO, OH 45066-9552
(937) 748-8814
(937) 748-8817
Mailing address
576 N MAIN ST, SPRINGBORO, OH 45066-9552
(937) 748-8814
(937) 748-8817
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21379
OH
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
79671
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2421132
—
OH
Enumeration date
07/09/2006
Last updated
01/09/2014
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