Provider Demographics
NPI:1417350075
Name:NADIMI, MOHAMAD H (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:H
Last Name:NADIMI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 WOLCOTT RD STE A
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2430
Mailing Address - Country:US
Mailing Address - Phone:203-879-9411
Mailing Address - Fax:
Practice Address - Street 1:504 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2430
Practice Address - Country:US
Practice Address - Phone:203-879-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist