Provider Demographics
NPI:1083054654
Name:KAZEMIZADEH GOL, JAVOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAVOD
Middle Name:
Last Name:KAZEMIZADEH GOL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 COLLINGTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716
Mailing Address - Country:US
Mailing Address - Phone:301-809-0029
Mailing Address - Fax:
Practice Address - Street 1:4321 COLLINGTON RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2259
Practice Address - Country:US
Practice Address - Phone:301-809-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist