Provider Demographics
NPI:1437403128
Name:REZAIE TIRABADI, OMEED ADAM (DDS)
Entity Type:Individual
Prefix:
First Name:OMEED
Middle Name:ADAM
Last Name:REZAIE TIRABADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SANDS RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21402-5009
Mailing Address - Country:US
Mailing Address - Phone:104-293-3946
Mailing Address - Fax:
Practice Address - Street 1:101 SANDS RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-5009
Practice Address - Country:US
Practice Address - Phone:410-293-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist