Provider Demographics
NPI:1134282668
Name:PISHDAD, FRIDOUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRIDOUN
Middle Name:
Last Name:PISHDAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 FALLS ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854
Mailing Address - Country:US
Mailing Address - Phone:301-983-2165
Mailing Address - Fax:301-299-0560
Practice Address - Street 1:10000 FALLS ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854
Practice Address - Country:US
Practice Address - Phone:301-983-2165
Practice Address - Fax:301-299-0560
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist