Provider Demographics
NPI:1346487592
Name:EMDADI, SHIDEH (DDS)
Entity Type:Individual
Prefix:
First Name:SHIDEH
Middle Name:
Last Name:EMDADI
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 1:23116 TIMBER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4019
Mailing Address - Country:US
Mailing Address - Phone:301-208-1811
Mailing Address - Fax:
Practice Address - Street 1:8 RUSSELL AVE
Practice Address - Street 2:104
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2966
Practice Address - Country:US
Practice Address - Phone:301-869-2500
Practice Address - Fax:301-926-7655
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice