Provider Demographics
NPI:1871892844
Name:MADANI, FARIDEH M (DMD)
Entity type:Individual
Prefix:DR
First Name:FARIDEH
Middle Name:M
Last Name:MADANI
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 1:15 N PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1006
Mailing Address - Country:US
Mailing Address - Phone:610-667-6161
Mailing Address - Fax:
Practice Address - Street 1:15 N PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1006
Practice Address - Country:US
Practice Address - Phone:610-667-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024793L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist