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General NPI Number Information
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NPI Number | 1629445630
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Entity Type | Organization
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Legal Business Name | FAY NAZARI DDS LLC
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 13360 CLARKSVILLE PIKE
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City | HIGHLAND
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State | MD
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Zip | 20777-9701
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Country | US
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Telephone | 301-854-2000
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Fax | 301-854-1122
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Provider Business Mailing Address
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Address Line | 13360 CLARKSVILLE PIKE
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City | HIGHLAND
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State | MD
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Zip | 20777-9701
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Country | US
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Telephone | 301-854-2000
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Fax | 301-854-1122
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Authorized Official
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Title or Position | DENTIST
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Name | DR. FAY NAZARI
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Credential | DDS
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Telephone | 301-854-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 15517
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 13973
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License Number State | MD
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