Provider Demographics
NPI:1649344680
Name:AMINI NEJAD, ELLAHE (DMD)
Entity type:Individual
Prefix:
First Name:ELLAHE
Middle Name:
Last Name:AMINI NEJAD
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 1:5016 DORSEY HALL DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELLIOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:410-740-1400
Mailing Address - Fax:410-740-1420
Practice Address - Street 1:5016 DORSEY HALL DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ELLIOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:410-740-1400
Practice Address - Fax:410-740-1420
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD99171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice