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Deactivated NPI 1306874029 Deactivated / Inactive NPI Female Practitioner

Dr. Maryam Moghadam , DDS

Dentist - General Practice • Evanston, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Maryam Moghadam has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date June 29, 2006
NPI Deactivation Date June 11, 2026
Total Practice Duration ~20 Years of Practice (2006 – 2026)

Professional Overview & Biography Verified Profile Summary

Dr. Maryam Moghadam, DDS was a registered Dentist - General Practice practicing in Evanston, IL. Throughout an active medical career spanning 20 years, Dr. Moghadam provided care at the practice location at 234 RIDGE AVE until profile deactivation on 2026-06-11.

Practice Location & Contact Primary Location

Practice Address

234 Ridge Ave
#1

Evanston, IL 602023349

Telephone 8478645491

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Evanston, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
61 Specialists

Practicing in Evanston, IL (5581 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License IL 019025836

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
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NPI Profile Deactivated June 11, 2026

Record deactivated on June 11, 2026

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Updated Business Mailing Address February 26, 2025

Registered at 22778 E POCO CALLE, QUEEN CREEK, AZ 851421449 (Tel: 8478486339)

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 26, 2025

Dentist (License #019025836 in IL)

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 26, 2020

Dentist (License #D010262 in AZ)

NPI Profile Active November 09, 2015

NPI status registered as active in NPPES database

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Updated Practice Location November 09, 2015

Registered at 234 RIDGE AVE, #1, EVANSTON, IL 602023349 (Tel: 8478645491)

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Updated Business Mailing Address November 09, 2015

Registered at 2556N LARAMIE AVE, CHICAGO, IL 606392452 (Tel: 7738893333)

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Provider Name / Credentials Updated November 09, 2015

Recorded as MARYAM MOGHADAM, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) November 09, 2015

Dentist (License #019025836 in IL)

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Initial NPI Registration & Enumeration June 29, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1306874029
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 29, 2006
Last Update: November 09, 2015
Deactivation Date: June 11, 2026

Mailing Address

2556n Laramie Ave

Chicago, IL 606392452

Phone: 7738893333

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.