Provider Demographics
NPI:1659667236
Name:POURAHMAD HAGHIGHI, PAYAM
Entity Type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:POURAHMAD HAGHIGHI
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 1:12116 DARNESTOWN RD STE L1
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2227
Mailing Address - Country:US
Mailing Address - Phone:301-258-7477
Mailing Address - Fax:
Practice Address - Street 1:12116 DARNESTOWN RD STE L1
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2227
Practice Address - Country:US
Practice Address - Phone:301-258-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14955122300000X
CA1079821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist