Provider Demographics
NPI:1205974771
Name:EMAM, MAHDIEH (DDS)
Entity type:Individual
Prefix:DR
First Name:MAHDIEH
Middle Name:
Last Name:EMAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EXECUTIVE PARK CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2645
Mailing Address - Country:US
Mailing Address - Phone:301-540-9000
Mailing Address - Fax:301-540-9910
Practice Address - Street 1:24 EXECUTIVE PARK CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2645
Practice Address - Country:US
Practice Address - Phone:301-540-9000
Practice Address - Fax:301-540-9910
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice