Gholamreza Memarsadeghi, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS029768-L Issued in PA

Practice address

333 S. Oxford Valley Rd.
Ste.#505
Fairless Hills, PA 19030

Phone

(215) 269-1430

Fax

(215) 269-4622

NPI assigned

May 9, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861606840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S. OXFORD VALLEY RD.",
            "address_2": "STE.#505",
            "city": "FAIRLESS HILLS",
            "state": "PA",
            "postal_code": "19030",
            "telephone_number": "215-269-1430",
            "fax_number": "215-269-4622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 S. OXFORD VALLEY RD.",
            "address_2": "STE.#505",
            "city": "FAIRLESS HILLS",
            "state": "PA",
            "postal_code": "19030",
            "telephone_number": "215-269-1430",
            "fax_number": "215-269-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMARSADEGHI",
        "first_name": "GHOLAMREZA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS029768-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Fairless Hills, PA
• Providers in Fairless Hills, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.