Provider Demographics
NPI:1700960721
Name:CHOOBINEH, MARYAM MEHDIZADEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:MEHDIZADEH
Last Name:CHOOBINEH
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 1:600 N COTNER BLVD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-464-8686
Mailing Address - Fax:402-464-8686
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-464-8686
Practice Address - Fax:402-464-8686
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47079711600Medicaid