Maryam Habibzadeh, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

0401417827 Issued in VA

Practice address

2612 Sheffield Dr
Blacksburg, VA 24060-8270

Phone

(517) 348-4842

NPI assigned

Aug 16, 2020

Last updated

Aug 1, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New River Periodontics and Dental Implant Center

  • Dental Clinic/Center
  • Blacksburg, VA
  • NPI 1841698016
  NPD (past)
• New River Periodontics and Dental Implant Center, PC

  • Periodontics
  • Blacksburg, VA
  • NPI 1881107100
  NPD (past)
• Gulf Coast Periodontics & Implants LLC

  • Periodontics
  • Gulfport, MS
  • NPI 1730759374
  NPD (past)
• St. Tammany Periodontics & Implants LLC

  • Periodontics
  • Covington, LA
  • NPI 1104496744
  NPD (past)

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

{
    "created_epoch": "1597536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1396356937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2612 SHEFFIELD DR",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240608270",
            "telephone_number": "517-348-4842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2612 SHEFFIELD DR",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240608270",
            "telephone_number": "517-348-4842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABIBZADEH",
        "first_name": "MARYAM",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-16",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "VA",
            "license": "0401417827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kati Griggs, LPC
• Lonnie Gross Jr., ATC
• Philip E Grubbs, MD
• Pete A. Guerra, M.D.
• Leonora Gyenai, OTR/L
• Allison Rae Hale, PT, DPT
• Amanda Mitchell Hale, FNP-C
• Andrea Lynn Hall, M.D.
• Kayla Mali Hall, LPC
• Ashley Marie Hallman

• Periodontics in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Periodontics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.