| Doctor Name: | A REZA MIREMADI |
| NPI Number: | 1982637922 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D., DDS., LLC |
| License Number: | 79671 |
| Business Practice Address: | 576 N Main St Springboro, OH - 450669552 |
| Business Phone Number: | 9377488814 |
| Business Fax Number: | 9377488817 |
| Mailing Address: | 576 N Main St, SPRINGBORO |
| State: | OH |
| Postal Code: | 450669552 |
| Phone Number: | 9377488814 |
| Fax Number: | 9377488817 |
| NPI Enumeration Date: | 07/09/2006 |
| NPI Last Update Date: | 01/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204E00000X |
| License Number: | 79671 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Oral & Maxillofacial Surgery |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |