MEDICARE: DR. SHEIDA NAKHAEI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13455	MD

General Provider Information

NPI Number	:	1356495246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEIDA NAKHAEI D.D.S.

Provider Business Mailing Address
First Line	:	2313 WESTPORT LN
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1210
Country	:	US
Telephone Number	:	410-721-6638
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 BELAIR RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-1822
Country	:	US
Telephone Number	:	410-254-8624
Fax Number	:	410-254-8670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/23/2022

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