Provider Demographics
NPI:1871595629
Name:ALIZADEH, CYRUS M (DDS)
Entity type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:M
Last Name:ALIZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17954 SADDLE HORN RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63038-1300
Mailing Address - Country:US
Mailing Address - Phone:636-458-2437
Mailing Address - Fax:
Practice Address - Street 1:1302 CLARKSON CLAYTON CTR
Practice Address - Street 2:SUITE 206
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2174
Practice Address - Country:US
Practice Address - Phone:636-394-5455
Practice Address - Fax:636-394-5163
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO144881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics