Provider Demographics
NPI:1801957089
Name:AHMADI, NIMA (DDS)
Entity type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:AHMADI
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 1:8203 STONETOWN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7239
Mailing Address - Country:US
Mailing Address - Phone:919-338-1011
Mailing Address - Fax:
Practice Address - Street 1:4237 LOUISBURG RD
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-4348
Practice Address - Country:US
Practice Address - Phone:919-865-8300
Practice Address - Fax:919-865-8301
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7946OtherDENTAL LICENSE