Provider Demographics
NPI:1568768059
Name:NABAVI, MOHAMMADREZA
Entity Type:Individual
Prefix:MR
First Name:MOHAMMADREZA
Middle Name:
Last Name:NABAVI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12903 ALDERLEAF DRIVE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:301-221-0161
Mailing Address - Fax:
Practice Address - Street 1:10 N GREENE STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-605-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDNOT YET LICENSED122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist