Provider Demographics
NPI:1528292141
Name:IZADI, ASHLEY (DDS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:IZADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N CHARLES ST
Mailing Address - Street 2:425
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5654
Mailing Address - Country:US
Mailing Address - Phone:410-382-0357
Mailing Address - Fax:
Practice Address - Street 1:5801 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-3742
Practice Address - Country:US
Practice Address - Phone:410-789-4455
Practice Address - Fax:410-789-4459
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist