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 1:625 ELMWOOD AVE # 683
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2913
Practice Address - Country:US
Practice Address - Phone:585-275-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program