Provider Demographics
NPI:1104487073
Name:AMEDY, HOMA (DMD)
Entity type:Individual
Prefix:DR
First Name:HOMA
Middle Name:
Last Name:AMEDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:HOMA
Other - Middle Name:
Other - Last Name:MIRZAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:804 CENTURY OAK CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7023
Mailing Address - Country:US
Mailing Address - Phone:615-635-7129
Mailing Address - Fax:
Practice Address - Street 1:4816 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174
Practice Address - Country:US
Practice Address - Phone:615-270-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist