Provider Demographics
NPI:1104074491
Name:MODARESZADEH-ESFAHANI, SEYED-MAHMOUDREZA (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:SEYED-MAHMOUDREZA
Middle Name:
Last Name:MODARESZADEH-ESFAHANI
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27060 CEDAR ROAD, APT. PH1
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-591-1293
Mailing Address - Fax:
Practice Address - Street 1:10900 EUCLID AVE.,
Practice Address - Street 2:CASE WESTERN RESERVE UNIVERSITY, DENTAL SCHOOL
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-368-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH25831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics