MEDICARE: DR. KHATEREH NEMATOLLAHI 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	13339	MD

General Provider Information

NPI Number	:	1710180021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHATEREH NEMATOLLAHI DDS

Provider Business Mailing Address
First Line	:	7201 WISCONSIN AVE
Second Line	:	SUITE #310
City	:	BETHESDA
State	:	MD
Zip	:	20814-4810
Country	:	US
Telephone Number	:	301-986-0032
Fax Number	:	301-986-0039

Provider Business Practice Location Address
First Line	:	7201 WISCONSIN AVE
Second Line	:	SUITE #310
City	:	BETHESDA
State	:	MD
Zip	:	20814-4810
Country	:	US
Telephone Number	:	301-986-0032
Fax Number	:	301-986-0039

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	09/30/2009

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