Provider Demographics
NPI:1003477639
Name:MOHAMMADI, NADIA (DDS)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:MOHAMMADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 FERN AVE APT 1210
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5783
Mailing Address - Country:US
Mailing Address - Phone:504-296-4115
Mailing Address - Fax:
Practice Address - Street 1:7251 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5104
Practice Address - Country:US
Practice Address - Phone:318-239-1638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist