Provider Demographics
NPI:1376672121
Name:POURSAEID, TANNAZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANNAZ
Middle Name:
Last Name:POURSAEID
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 1:19735 GERMANTOWN RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1214
Mailing Address - Country:US
Mailing Address - Phone:301-972-3311
Mailing Address - Fax:301-972-1822
Practice Address - Street 1:19735 GERMANTOWN RD
Practice Address - Street 2:SUITE 250
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1214
Practice Address - Country:US
Practice Address - Phone:301-972-3311
Practice Address - Fax:301-972-1822
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry