MEDICARE: MOHAMMED HOMER NAIMEE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12554	CT

General Provider Information

NPI Number	:	1194386185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMED HOMER NAIMEE DDS

Provider Business Mailing Address
First Line	:	1619 COLONIAL HILLS DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-2940
Country	:	US
Telephone Number	:	703-629-0514
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 YORK ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-5608
Country	:	US
Telephone Number	:	703-629-0514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	06/21/2019

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