Provider Demographics
NPI:1821149287
Name:MALAKSHAHI MINOVI, LIZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:
Last Name:MALAKSHAHI MINOVI
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 1:1234 19TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2407
Mailing Address - Country:US
Mailing Address - Phone:202-822-8777
Mailing Address - Fax:202-822-8775
Practice Address - Street 1:1234 19TH ST NW
Practice Address - Street 2:SUITE 400
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2407
Practice Address - Country:US
Practice Address - Phone:202-822-8777
Practice Address - Fax:202-822-8775
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCD5259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist