Provider Demographics
NPI:1902937154
Name:MADANI, HAMIDREZA (DMD)
Entity type:Individual
Prefix:DR
First Name:HAMIDREZA
Middle Name:
Last Name:MADANI
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 THORNBERRY COURT, STE 120
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7841
Mailing Address - Country:US
Mailing Address - Phone:513-398-8777
Mailing Address - Fax:513-398-8761
Practice Address - Street 1:6408 THORNBERRY CT STE 120
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7841
Practice Address - Country:US
Practice Address - Phone:513-398-8777
Practice Address - Fax:513-398-8761
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH203171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice