Active NPI
Mitra Madani, D.D.S.
- General Practice Dentistry
- Severna Park, MD
National Provider Identifier
1174678718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13564
- Practice address
- 517 Benfield Rd
Suite 204
Severna Park, MD 21146-2527 - Phone
- (410) 647-7050
- Fax
- (410) 647-7051
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13564 | MD | Primary |
Addresses
Primary practice location
517 Benfield Rd
Suite 204
Severna Park, MD 21146-2527
Mailing address
517 Benfield Rd
Suite 204
Severna Park, MD 21146-2527
Phone (410) 647-7050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2016 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13564 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mitra Madani, D.D.S, LLC | Current | Accepting new patients |
Locations
517 Benfield Rd
Ste 204
Severna Park, MD 21146
Phone (410) 647-7050
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Bayside Family Dentistry
- Durable Medical Equipment & Medical Supplies
- Severna Park, MD
- NPI 1023602695
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400716800000",
"number": "1174678718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "517 BENFIELD RD",
"address_2": "SUITE 204",
"city": "SEVERNA PARK",
"state": "MD",
"postal_code": "211462527",
"telephone_number": "410-647-7050",
"fax_number": "410-647-7051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "517 BENFIELD RD",
"address_2": "SUITE 204",
"city": "SEVERNA PARK",
"state": "MD",
"postal_code": "211462527",
"telephone_number": "410-647-7050",
"fax_number": "410-647-7051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADANI",
"first_name": "MITRA",
"name_prefix": "Mrs.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2014-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "13564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Severna Park, MD
- Luminis Health Medical Group, LLC (Anne Arundel Medical Group-Severna Park Primary Care)
- Luminis Health Medical Group, LLC
- Luminis Health Medical Group, LLC (AAMG GYN Oncology Specialists)
- Luminous Smile, Corp.
- Jennifer Ann Lute, OTR/L
- Magothy River Counseling LLC
- Daniel Mahoney, ATC/L
- Jared Emerson Mallalieu, D.O.
- Katrina Marie Mamuzich, AAS, PTA, COPTA
- Radmila Mandelblatt, MA, OT L
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.