Healthcare Provider Details

I. General information

NPI: 1184079188
Provider Name (Legal Business Name): MAHDI SEYED ABDOL EMAMIAN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

2 RED KILN CT
GAITHERSBURG MD
20878-2704
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-4213
  • Fax:
Mailing address:
  • Phone: 240-644-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15889
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: