Provider Demographics
NPI:1427272475
Name:REZVANI, FEREIDOON (DDS)
Entity type:Individual
Prefix:
First Name:FEREIDOON
Middle Name:
Last Name:REZVANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 EYE STREET NW
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:202-331-0655
Mailing Address - Fax:202-331-8558
Practice Address - Street 1:1712 EYE STREET NW
Practice Address - Street 2:SUITE 600
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-331-0655
Practice Address - Fax:202-331-8558
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC000043801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice