Provider Demographics
NPI:1942182431
Name:TAGHIZADEH JAZDANI, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:TAGHIZADEH JAZDANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 ANSEL RD APT 212
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4119
Mailing Address - Country:US
Mailing Address - Phone:408-915-9115
Mailing Address - Fax:
Practice Address - Street 1:6268 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3219
Practice Address - Country:US
Practice Address - Phone:440-684-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.028163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist