=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316199011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAYEREH GHAMARIAN, D.D.S. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2008
-----------------------------------------------------
Last Update Date | 10/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6017 BRADLEY BOULEVARD
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-365-3626
-----------------------------------------------------
Fax | 301-767-3265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6017 BRADLEY BOULEVARD
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-365-3626
-----------------------------------------------------
Fax | 301-767-3265
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NAYEREH NINA GHAMARIAN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 301-365-3626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 10614
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------