Provider Demographics
NPI:1710439328
Name:MAHMOUDI, TINA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:MAHMOUDI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11810 W. MARKET PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-4856
Mailing Address - Country:US
Mailing Address - Phone:443-393-3241
Mailing Address - Fax:443-393-3246
Practice Address - Street 1:11810 W MARKET PL STE 203
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2703
Practice Address - Country:US
Practice Address - Phone:443-393-3241
Practice Address - Fax:443-393-3246
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-30
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics