Provider Demographics
NPI:1992313894
Name:BEHMARDI, OMEED (DMD)
Entity type:Individual
Prefix:
First Name:OMEED
Middle Name:
Last Name:BEHMARDI
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 1:5997 NW 73RD CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2609 SANTA BARBARA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4457
Practice Address - Country:US
Practice Address - Phone:239-652-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-09-24
Deactivation Date:2020-09-04
Deactivation Code:
Reactivation Date:2020-09-23
Provider Licenses
StateLicense IDTaxonomies
FL25183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist