Provider Demographics
NPI:1679182323
Name:NATEGHI, ARDALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARDALAN
Middle Name:
Last Name:NATEGHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 STATE ROUTE 3 S STE 211
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1776
Mailing Address - Country:US
Mailing Address - Phone:410-721-2409
Mailing Address - Fax:
Practice Address - Street 1:1166 STATE ROUTE 3 S STE 211
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1776
Practice Address - Country:US
Practice Address - Phone:410-721-2409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice