Provider Demographics
NPI:1417455171
Name:NADIMI DENTAL CARE LLC
Entity Type:Organization
Organization Name:NADIMI DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:HADI
Authorized Official - Last Name:NADIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-879-9411
Mailing Address - Street 1:504 WOLCOTT RD STE 1A
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:203-441-4375
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:203-441-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1417350075Medicaid