Provider Demographics
NPI:1053491001
Name:PAKPOUR, DESABEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DESABEH
Middle Name:
Last Name:PAKPOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1003
Mailing Address - Country:US
Mailing Address - Phone:301-982-3330
Mailing Address - Fax:301-345-1224
Practice Address - Street 1:5510 CHERRYWOOD LN
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1003
Practice Address - Country:US
Practice Address - Phone:301-982-3330
Practice Address - Fax:301-345-1224
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist