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General NPI Number Information
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NPI Number | 1750126892
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Entity Type | Individual
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Provider Name | NADER SIDHOM DMD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2024
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 9500 LIVINGSTON RD STE 105
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-4973
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Country | US
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Telephone | 301-203-3944
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Fax |
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Provider Business Mailing Address
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Address Line | 40 PATTERSON ST NE APT 1223
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City | WASHINGTON
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State | DC
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Zip | 20002-8289
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Country | US
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Telephone | 703-883-7777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN2000400
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18443
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License Number State | MD
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