Provider Demographics
NPI:1528281250
Name:SHAHAMAT, AHDIEH (DDS)
Entity type:Individual
Prefix:DR
First Name:AHDIEH
Middle Name:
Last Name:SHAHAMAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:SHEILA
Other - Last Name:SHAHAMAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1924 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1802
Mailing Address - Country:US
Mailing Address - Phone:614-457-4303
Mailing Address - Fax:614-457-1173
Practice Address - Street 1:1924 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1802
Practice Address - Country:US
Practice Address - Phone:614-457-4303
Practice Address - Fax:614-457-1173
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty