Provider Demographics
NPI:1881070530
Name:ALIZADEH, MINA BARADARAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:BARADARAN
Last Name:ALIZADEH
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 GUNPOWDER RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9460
Mailing Address - Country:US
Mailing Address - Phone:410-375-6685
Mailing Address - Fax:
Practice Address - Street 1:24 GUNPOWDER RD
Practice Address - Street 2:
Practice Address - City:GLEN ARM
Practice Address - State:MD
Practice Address - Zip Code:21057-9460
Practice Address - Country:US
Practice Address - Phone:410-375-6685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist