Provider Demographics
NPI:1801844204
Name:DELDAR, MOHAMMAD H (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:H
Last Name:DELDAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:H
Other - Last Name:DELDAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:14753 HAZEL DELL XING
Mailing Address - Street 2:SUITE 700
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7025
Mailing Address - Country:US
Mailing Address - Phone:317-208-0000
Mailing Address - Fax:317-208-4704
Practice Address - Street 1:14753 HAZEL DELL XING
Practice Address - Street 2:SUITE 700
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7025
Practice Address - Country:US
Practice Address - Phone:317-208-0000
Practice Address - Fax:317-208-4704
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist