Provider Demographics
NPI:1528223740
Name:MIRDAMADI, BEHZAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEHZAD
Middle Name:
Last Name:MIRDAMADI
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 1:18218 FLOWER HILL WAY
Mailing Address - Street 2:DENTAL SUITE HABIBI AND MIRDAMADI, D.D.S., P.A.
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879
Mailing Address - Country:US
Mailing Address - Phone:301-963-0665
Mailing Address - Fax:
Practice Address - Street 1:18218 FLOWER HILL WAY
Practice Address - Street 2:DENTAL SUITE HABIBI AND MIRDAMADI, D.D.S., P.A.
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879
Practice Address - Country:US
Practice Address - Phone:301-963-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist