Healthcare Provider Details

I. General information

NPI: 1871554501
Provider Name (Legal Business Name): AMIR H ZOLFAGHARI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N SUMMIT AVE
GAITHERSBURG MD
20877-2920
US

IV. Provider business mailing address

104 N SUMMIT AVE
GAITHERSBURG MD
20877-2920
US

V. Phone/Fax

Practice location:
  • Phone: 301-527-7710
  • Fax: 301-527-1114
Mailing address:
  • Phone: 301-527-7710
  • Fax: 301-527-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12190
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: