Healthcare Provider Details

I. General information

NPI: 1194041863
Provider Name (Legal Business Name): RIAAZ NAEEM ALIE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 URBANA PIKE
IJAMSVILLE MD
21754-9435
US

IV. Provider business mailing address

449 CLAYHALL ST
GAITHERSBURG MD
20878-6501
US

V. Phone/Fax

Practice location:
  • Phone: 301-518-7772
  • Fax:
Mailing address:
  • Phone: 301-518-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14358
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: