Provider Demographics
NPI:1194560011
Name:GHANDEHARIZADEH, ARYA (DMD)
Entity type:Individual
Prefix:DR
First Name:ARYA
Middle Name:
Last Name:GHANDEHARIZADEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08829-1902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08829-1902
Practice Address - Country:US
Practice Address - Phone:908-617-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030305001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice