Provider Demographics
NPI:1194738146
Name:MOHAMMADI, VALI M (DMD)
Entity type:Individual
Prefix:DR
First Name:VALI
Middle Name:M
Last Name:MOHAMMADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 SUMMERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5479
Mailing Address - Country:US
Mailing Address - Phone:914-472-2929
Mailing Address - Fax:
Practice Address - Street 1:10 LIBERTY ST
Practice Address - Street 2:15C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-1529
Practice Address - Country:US
Practice Address - Phone:617-331-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0515581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry