Provider Demographics
NPI:1235280652
Name:NEZAKATGOO, LEILA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:NEZAKATGOO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 MARINELLI RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2500
Mailing Address - Country:US
Mailing Address - Phone:202-277-6730
Mailing Address - Fax:301-620-9739
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE #103
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:301-620-9666
Practice Address - Fax:301-620-9739
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics