Provider Demographics
NPI:1447523725
Name:ELYAHOUZADEH, RONY (DDS)
Entity type:Individual
Prefix:
First Name:RONY
Middle Name:
Last Name:ELYAHOUZADEH
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 1:444 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1901
Mailing Address - Country:US
Mailing Address - Phone:908-353-6655
Mailing Address - Fax:908-353-5566
Practice Address - Street 1:444 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1901
Practice Address - Country:US
Practice Address - Phone:908-353-6655
Practice Address - Fax:908-353-5566
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI202231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice