Provider Demographics
NPI:1598811630
Name:GHAZAI, LILI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILI
Middle Name:
Last Name:GHAZAI
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 1:15825 SHADY GROVE RD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4008
Mailing Address - Country:US
Mailing Address - Phone:301-825-9245
Mailing Address - Fax:
Practice Address - Street 1:15825 SHADY GROVE RD
Practice Address - Street 2:SUITE #120
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4008
Practice Address - Country:US
Practice Address - Phone:301-825-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice