Provider Demographics
NPI:1306949904
Name:NADIMI, ABDOLLAH (DDS)
Entity type:Individual
Prefix:DR
First Name:ABDOLLAH
Middle Name:
Last Name:NADIMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 WOLCOTT RD STE A
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2430
Mailing Address - Country:US
Mailing Address - Phone:203-879-9411
Mailing Address - Fax:203-879-9383
Practice Address - Street 1:504 WOLCOTT RD STE A
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2430
Practice Address - Country:US
Practice Address - Phone:203-879-9411
Practice Address - Fax:203-879-9383
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0084951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002084953Medicaid