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General NPI Number Information
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NPI Number | 1033565528
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Entity Type | Organization
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Legal Business Name | FATEMI FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 604 S FREDERICK AVE #209
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City | GAITHERSBURG
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State | MD
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Zip | 20877-1275
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Country | US
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Telephone | 301-740-2686
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Fax |
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Provider Business Mailing Address
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Address Line | 64 SOUTH FREDERICK AVE #209
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City | GAITHERSBURG
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State | MD
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Zip | 20877
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Country | US
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Telephone | 301-740-2686
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Fax | 240-238-2921
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Authorized Official
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Title or Position | DENTIST
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Name | MOHAMMAD FATEMI
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Credential | DDS
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Telephone | 301-740-2686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 11720
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License Number State | MD
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