Provider Demographics
NPI:1841182151
Name:ALIZADEGAN, ALIREZA
Entity type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:ALIZADEGAN
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 1:200 MIDDLETOWN BLVD UNIT 4085
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1956
Mailing Address - Country:US
Mailing Address - Phone:901-501-9468
Mailing Address - Fax:
Practice Address - Street 1:670 ROCKHILL DR
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1626
Practice Address - Country:US
Practice Address - Phone:215-876-6768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS045294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist