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General NPI Number Information
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NPI Number | 1700960721
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Entity Type | Individual
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Provider Name | MARYAM MEHDIZADEH CHOOBINEH DDS
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 600 N COTNER BLVD SUITE #300
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City | LINCOLN
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State | NE
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Zip | 68505-2343
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Country | US
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Telephone | 402-464-8686
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Fax | 402-464-8686
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Provider Business Mailing Address
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Address Line | 600 N COTNER BLVD SUITE #300
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City | LINCOLN
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State | NE
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Zip | 68505-2343
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Country | US
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Telephone | 402-464-8686
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Fax | 402-464-8686
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5948
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License Number State | NE
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