Individual
MARYAM MAHDAVI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
978 ROCKAWAY AVE, VALLEY STREAM, NY 11581-2136
(617) 909-6118
Mailing address
80 FAIRVIEW AVE, BELMONT, MA 02478-3766
(617) 909-6118
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
060887-01
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2016
Last updated
10/22/2021
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