Provider Demographics
NPI:1265665590
Name:MIAMEE, GHOLAMALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:GHOLAMALI
Middle Name:
Last Name:MIAMEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GHOLAM
Other - Middle Name:ALI
Other - Last Name:MIAMEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1760 RESTON PKWY
Mailing Address - Street 2:SUITE 415
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3388
Mailing Address - Country:US
Mailing Address - Phone:703-956-9444
Mailing Address - Fax:
Practice Address - Street 1:1760 RESTON PKWY
Practice Address - Street 2:SUITE 415
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3388
Practice Address - Country:US
Practice Address - Phone:703-956-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist