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General NPI Number Information
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NPI Number | 1871014795
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Entity Type | Organization
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Legal Business Name | MARYAM HAERI, DDS, PLLC.
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 1145 19TH ST NW STE 508
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City | WASHINGTON
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State | DC
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Zip | 20036-3715
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Country | US
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Telephone | 202-826-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 11800 OLD GEORGETOWN RD APT 1426
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City | ROCKVILLE
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State | MD
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Zip | 20852-2654
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Country | US
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Telephone | 949-439-1212
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Fax |
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Authorized Official
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Title or Position | OWNER/ GENERAL DENTIST
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Name | DR. MARYAM HARI
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Credential | DDS
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Telephone | 202-826-7000
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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 | DEN1000289
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License Number State | DC
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