Provider Demographics
NPI:1821980772
Name:KIANY, MAHDIEH (DMD)
Entity type:Individual
Prefix:
First Name:MAHDIEH
Middle Name:
Last Name:KIANY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N MISSOURI AVE # 634
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-1561
Mailing Address - Country:US
Mailing Address - Phone:310-505-4627
Mailing Address - Fax:
Practice Address - Street 1:43522 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6812
Practice Address - Country:US
Practice Address - Phone:863-777-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL307221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice