Provider Demographics
NPI:1790005726
Name:GHADIMIAN, EVELYN
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:GHADIMIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PARIS AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-2042
Mailing Address - Country:US
Mailing Address - Phone:201-750-3300
Mailing Address - Fax:
Practice Address - Street 1:160 PARIS AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-2042
Practice Address - Country:US
Practice Address - Phone:201-750-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01990205122300000X
NY044388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist