Provider Demographics
NPI:1144392812
Name:STALEY-NEITHER, NEKIA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEKIA
Middle Name:A
Last Name:STALEY-NEITHER
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 1:6117 MARLBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2102
Mailing Address - Country:US
Mailing Address - Phone:301-735-3006
Mailing Address - Fax:301-735-3062
Practice Address - Street 1:6117 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2102
Practice Address - Country:US
Practice Address - Phone:301-735-3006
Practice Address - Fax:301-735-3062
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134581223G0001X
DCDEN10004341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036291500Medicaid