Provider Demographics
NPI:1336661388
Name:MEYER, SAMEERA GHARAGOZLOO (DDS)
Entity Type:Individual
Prefix:
First Name:SAMEERA
Middle Name:GHARAGOZLOO
Last Name:MEYER
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 1:117 SAINT PATRICKS DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4574
Mailing Address - Country:US
Mailing Address - Phone:301-870-4553
Mailing Address - Fax:301-870-7034
Practice Address - Street 1:6671B BACKLICK RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2702
Practice Address - Country:US
Practice Address - Phone:703-992-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist