BROOKE MAHDAVI DMD
NPI 1184283111
Dentist - Orthodontics and Dentofacial Orthopedics in Atlanta, GA

Active since June 12, 2019Opted out of Medicare · through Jan 15, 2027
955 MEMORIAL DR SE STE 530, ATLANTA, GA 30316(770) 800-5802 Get Directions Write a Review

NPPES record last updated: March 12, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 12, 2023, Jan 24, 2021, Jan 12, 2021 and 1 more (4 updates tracked since 2019).

About Brooke Mahdavi Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROOKE MAHDAVI DMD (NPI 1184283111) is an individual orthodontics and dentofacial orthopedics provider in Atlanta, Georgia, licensed in Georgia (DN015346) and active in the NPI registry since June 2019. She has opted out of Medicare through January 15, 2027 and maintains a secondary practice location in Fayetteville.

NPPES Registry Identity

NPI1184283111
Entity TypeIndividualFemale
Primary Taxonomy1223X0400X
Provider Legal NameBROOKE MAHDAVICredential: DMD
Location Address955 MEMORIAL DR SE STE 530Atlanta, GA 30316-1566
Mailing Address55 Chester Ave SeAtlanta, GA 30316-1201 · (239) 940-0867
Sole ProprietorYes
Enumeration DateJune 12, 2019
Last NPPES UpdateMarch 12, 20234 updates tracked since enumeration
NPPES CertifiedMarch 12, 2023
NPI 1184283111 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentist · Orthodontics and Dentofacial OrthopedicsDental Providers
Taxonomy Code1223X0400X
License Licensed in GA · DN015346
Definition
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.
955 MEMORIAL DR SE STE 530, Atlanta, GA 30316

Secondary Practice Location 1

Location 1100 Carnegie Pl Ste 102Fayetteville, GA 30214-3905 · Phone (239) 940-0867

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Brooke Mahdavi Dmd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 15, 2025 through January 15, 2027.

Opt-Out Effective DateJanuary 15, 2025
Opt-Out In Effect ThroughJanuary 15, 2027Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brooke Mahdavi's NPI number?

The NPI number for Brooke Mahdavi is 1184283111. It was assigned to this individual provider in the NPPES registry on June 12, 2019.

Where is Brooke Mahdavi located?

Brooke Mahdavi practices at 955 Memorial Dr SE Ste 530, Atlanta, GA 30316. The listed phone number is (770) 800-5802.

What is Brooke Mahdavi's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Orthodontics and Dentofacial Orthopedics, with taxonomy code 1223X0400X.

Is Brooke Mahdavi enrolled in Medicare?

No. Brooke Mahdavi has opted out of Medicare through January 15, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Brooke Mahdavi accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 10 other insurers list Brooke Mahdavi as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Brooke Mahdavi was last updated on March 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.