Provider Demographics
NPI:1497834097
Name:MOAZAMI, NEGIN (DDS)
Entity Type:Individual
Prefix:
First Name:NEGIN
Middle Name:
Last Name:MOAZAMI
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 1:8630 FENTON ST
Mailing Address - Street 2:SUITE #902
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-589-1143
Mailing Address - Fax:301-588-3764
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE #902
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-589-1143
Practice Address - Fax:301-588-3764
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice