Healthcare Provider Details

I. General information

NPI: 1689709255
Provider Name (Legal Business Name): FAY NAZARI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13360 CLARKSVILLE PIKE
HIGHLAND MD
20777-9701
US

IV. Provider business mailing address

13360 CLARKSVILLE PIKE
HIGHLAND MD
20777-9701
US

V. Phone/Fax

Practice location:
  • Phone: 301-854-2000
  • Fax: 301-854-1122
Mailing address:
  • Phone: 301-854-2000
  • Fax: 301-854-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13973
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: