Provider Demographics
NPI:1760504021
Name:NAZEMZADEH, NASSER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NASSER
Middle Name:
Last Name:NAZEMZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DEAN
Other - Middle Name:N
Other - Last Name:NAZEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11125 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE# G2
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:301-770-9007
Mailing Address - Fax:301-770-9507
Practice Address - Street 1:11125 ROCKVILLE PIKE
Practice Address - Street 2:SUIE#G2
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-770-9007
Practice Address - Fax:301-770-9507
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD117951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice