Provider Demographics
NPI:1417246273
Name:BAHMADI MOGHADDAM, NEDA (DMD)
Entity Type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:BAHMADI MOGHADDAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NEDAS
Other - Middle Name:
Other - Last Name:BAHMADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:850 NW 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 NW 115TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-1500
Practice Address - Country:US
Practice Address - Phone:917-386-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist