Provider Demographics
NPI:1487382065
Name:FEIZIZAD, MOHAMMAD (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:FEIZIZAD
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 1:2260 PLYMOUTH RD APT 113
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2352
Mailing Address - Country:US
Mailing Address - Phone:206-631-0352
Mailing Address - Fax:
Practice Address - Street 1:11300 WAYZATA BLVD STE G
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305-2019
Practice Address - Country:US
Practice Address - Phone:206-631-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist