Provider Demographics
NPI:1952539793
Name:SAMADZAI, AHMAD WALID
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:WALID
Last Name:SAMADZAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AHMAD
Other - Middle Name:WALID
Other - Last Name:SAMADZAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:625 E PRESCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-825-7251
Mailing Address - Fax:785-285-6221
Practice Address - Street 1:651 EAST PRESCOTT AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7408
Practice Address - Country:US
Practice Address - Phone:785-825-7251
Practice Address - Fax:785-285-6221
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS607001223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health