Provider Demographics
NPI:1548874977
Name:REZA, SYED HAMMAD (DDS)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:HAMMAD
Last Name:REZA
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 1:840 S LYNN RIGGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-8301
Mailing Address - Country:US
Mailing Address - Phone:214-662-7869
Mailing Address - Fax:
Practice Address - Street 1:3316 LAKEVIEW PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-3365
Practice Address - Country:US
Practice Address - Phone:972-535-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK73771223G0001X
TX373571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice