Provider Demographics
NPI:1629445630
Name:FAY NAZARI DDS LLC
Entity Type:Organization
Organization Name:FAY NAZARI DDS LLC
Other - Org Name:HIGHLAND FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-854-2000
Mailing Address - Street 1:13360 CLARKSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777-9701
Mailing Address - Country:US
Mailing Address - Phone:301-854-2000
Mailing Address - Fax:301-854-1122
Practice Address - Street 1:13360 CLARKSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MD
Practice Address - Zip Code:20777-9701
Practice Address - Country:US
Practice Address - Phone:301-854-2000
Practice Address - Fax:301-854-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13973261QD0000X
MD15517261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental