Provider Demographics
NPI:1548539489
Name:NAIMOV, SADRIDDIN (DMD)
Entity type:Individual
Prefix:DR
First Name:SADRIDDIN
Middle Name:
Last Name:NAIMOV
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 1:442 SW UMATILLA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7039
Mailing Address - Country:US
Mailing Address - Phone:888-468-0022
Mailing Address - Fax:
Practice Address - Street 1:2530 SHASTA WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4356
Practice Address - Country:US
Practice Address - Phone:541-810-7040
Practice Address - Fax:541-516-4049
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056577122300000X
ORD93681223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500678241Medicaid
NY056577OtherLICENSE
NY04595915Medicaid