Provider Demographics
NPI:1710180021
Name:NEMATOLLAHI, KHATEREH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHATEREH
Middle Name:
Last Name:NEMATOLLAHI
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 1:7201 WISCONSIN AVE
Mailing Address - Street 2:SUITE #310
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4810
Mailing Address - Country:US
Mailing Address - Phone:301-986-0032
Mailing Address - Fax:301-986-0039
Practice Address - Street 1:7201 WISCONSIN AVE
Practice Address - Street 2:SUITE #310
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4810
Practice Address - Country:US
Practice Address - Phone:301-986-0032
Practice Address - Fax:301-986-0039
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice