Healthcare Provider Details

I. General information

NPI: 1003593542
Provider Name (Legal Business Name): THAMEANEH TABATABAEIFAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW STE 511
WASHINGTON DC
20015-2024
US

IV. Provider business mailing address

5 WEBB RD
CABIN JOHN MD
20818-1807
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-0620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN2000282
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: