MEDICARE: DR. MAHDIEH EMAM D.D.S

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	13296	MD

General Provider Information

NPI Number	:	1205974771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHDIEH EMAM D.D.S

Provider Business Mailing Address
First Line	:	24 EXECUTIVE PARK CT
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2645
Country	:	US
Telephone Number	:	301-540-9000
Fax Number	:	301-540-9910

Provider Business Practice Location Address
First Line	:	24 EXECUTIVE PARK CT
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2645
Country	:	US
Telephone Number	:	301-540-9000
Fax Number	:	301-540-9910

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

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	07/08/2007

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