Provider Demographics
NPI:1891489753
Name:SIADAT, AMIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:SIADAT
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 1:2021 10TH AVE S APT 909
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2739
Mailing Address - Country:US
Mailing Address - Phone:716-275-6981
Mailing Address - Fax:
Practice Address - Street 1:2103 W PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2946
Practice Address - Country:US
Practice Address - Phone:410-888-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007275-C1122300000X
MD18009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist