Provider Demographics
NPI:1710967252
Name:HAMIDI, MARIAM ALEXES (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:ALEXES
Last Name:HAMIDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2193 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-1707
Mailing Address - Country:US
Mailing Address - Phone:307-509-9735
Mailing Address - Fax:800-952-8830
Practice Address - Street 1:322 SE 192ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9679
Practice Address - Country:US
Practice Address - Phone:360-262-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD107871223P0106X
COD92811223S0112X
WADE000092071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology