Provider Demographics
NPI:1164253407
Name:HABIBI-TANHA, MOHAMMAD-KAZEM (DMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD-KAZEM
Middle Name:
Last Name:HABIBI-TANHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:KAZEM
Other - Middle Name:
Other - Last Name:HABIBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:625 GOODMAN ST S APT 227
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 PARK ST STE 2
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1251
Practice Address - Country:US
Practice Address - Phone:518-481-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0646441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice