Provider Demographics
NPI:1235307257
Name:SHATERGHOLI, MELIKA (DDS)
Entity Type:Individual
Prefix:MISS
First Name:MELIKA
Middle Name:
Last Name:SHATERGHOLI
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 1:3327 SUPERIOR LANE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715
Mailing Address - Country:US
Mailing Address - Phone:240-678-3658
Mailing Address - Fax:310-464-2125
Practice Address - Street 1:3327 SUPERIOR LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:240-678-3658
Practice Address - Fax:310-464-2125
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice