Provider Demographics
NPI:1073780821
Name:EMAMI, MEHRDAD (MA,DDS)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:EMAMI
Suffix:
Gender:M
Credentials:MA,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 S YALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7092
Mailing Address - Country:US
Mailing Address - Phone:918-496-8010
Mailing Address - Fax:
Practice Address - Street 1:7320 S YALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7092
Practice Address - Country:US
Practice Address - Phone:918-496-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice