Mohammad - Izadidehkordi, D.D.S

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

11080 Issued in MD

Practice address

12209 Tullamore Rd
Timonium, MD 21093-7816

Phone

(410) 560-0360

Fax

(410) 560-0364

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Mohammad - Izadi Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1164440608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 LAKE POTOMAC DR",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208541216",
            "telephone_number": "301-983-0818",
            "fax_number": "301-983-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12209 TULLAMORE RD",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210937816",
            "telephone_number": "410-560-0360",
            "fax_number": "410-560-0364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IZADIDEHKORDI",
        "first_name": "MOHAMMAD",
        "middle_name": "-",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MD",
            "license": "11080",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "VA",
            "license": "0401008006",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOHAMMAD",
            "last_name": "IZADI",
            "middle_name": "-",
            "prefix": "DR.",
            "credential": "DD.S",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Timonium, MD
• Providers in Timonium, MD by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.