Active NPI
Mohammadreza Alizadegan Makhsos
- Dentist
- Liberty Township, OH
National Provider Identifier
1801429238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 20403
- Practice address
- 5884 Kensington TRL
Liberty Township, OH 45044-8895 - Phone
- (901) 498-1133
- NPI assigned
- Feb 13, 2020
- Last updated
- Feb 13, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 20403 | OH | Primary |
Addresses
Primary practice location
5884 Kensington TRL
Liberty Township, OH 45044-8895
Mailing address
5884 Kensington TRL
Liberty Township, OH 45044-8895
Phone (901) 498-1133
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | URL | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20403 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581552000000",
"number": "1801429238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5884 KENSINGTON TRL",
"city": "LIBERTY TOWNSHIP",
"state": "OH",
"postal_code": "450448895",
"telephone_number": "901-498-1133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5884 KENSINGTON TRL",
"city": "LIBERTY TOWNSHIP",
"state": "OH",
"postal_code": "450448895",
"telephone_number": "901-498-1133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALIZADEGAN MAKHSOS",
"first_name": "MOHAMMADREZA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-02-13",
"last_updated": "2020-02-13",
"certification_date": "2020-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "20403",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "URL",
"affiliation": "N",
"endpointDescription": "HIE",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "5884 Kensington Trl",
"city": "Liberty Township",
"state": "OH",
"country_code": "US",
"postal_code": "450448895",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Liberty Township, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.