Provider Demographics
NPI:1033565528
Name:FATEMI FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:FATEMI FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FATEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-740-2686
Mailing Address - Street 1:64 SOUTH FREDERICK AVE #209
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877
Mailing Address - Country:US
Mailing Address - Phone:301-740-2686
Mailing Address - Fax:240-238-2921
Practice Address - Street 1:604 S FREDERICK AVE
Practice Address - Street 2:#209
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1275
Practice Address - Country:US
Practice Address - Phone:301-740-2686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD117201223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty