Provider Demographics
NPI:1326294505
Name:HABIBI & MIRDAMADI D.D.S, PA.
Entity Type:Organization
Organization Name:HABIBI & MIRDAMADI D.D.S, PA.
Other - Org Name:DENTAL SUITE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRDAMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-963-0665
Mailing Address - Street 1:18218 FLOWER HILL WAY
Mailing Address - Street 2:DENTAL SUITE HABIBI AND MIRDAMADI, D.D.S., P.A.
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879
Mailing Address - Country:US
Mailing Address - Phone:301-963-0665
Mailing Address - Fax:
Practice Address - Street 1:18218 FLOWER HILL WAY
Practice Address - Street 2:DENTAL SUITE HABIBI AND MIRDAMADI, D.D.S., P.A.
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879
Practice Address - Country:US
Practice Address - Phone:301-963-0665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty