Provider Demographics
NPI:1326255068
Name:EMAMI, NASSER (DMD DDS)
Entity Type:Individual
Prefix:DR
First Name:NASSER
Middle Name:
Last Name:EMAMI
Suffix:
Gender:M
Credentials:DMD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 JOHNSON RD
Mailing Address - Street 2:STE 203
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2372
Mailing Address - Country:US
Mailing Address - Phone:740-264-5300
Mailing Address - Fax:740-264-4548
Practice Address - Street 1:4100 JOHNSON RD
Practice Address - Street 2:STE 203
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2372
Practice Address - Country:US
Practice Address - Phone:740-264-5300
Practice Address - Fax:740-264-4548
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0142481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000128896OtherANTHEM BCBS
000070624OtherMT STATE BCBS
000000128896OtherANTHEM BCBS
T46145Medicare UPIN
WV0351104Medicare ID - Type Unspecified