Provider Demographics
NPI:1508545195
Name:ZIJERDI, NAZ
Entity Type:Individual
Prefix:
First Name:NAZ
Middle Name:
Last Name:ZIJERDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3724
Mailing Address - Country:US
Mailing Address - Phone:703-599-9119
Mailing Address - Fax:
Practice Address - Street 1:10007 STEDWICK RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3710
Practice Address - Country:US
Practice Address - Phone:240-528-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist