Provider Demographics
NPI:1871014795
Name:MARYAM HAERI, DDS, PLLC.
Entity Type:Organization
Organization Name:MARYAM HAERI, DDS, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-826-7000
Mailing Address - Street 1:11800 OLD GEORGETOWN RD APT 1426
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2654
Mailing Address - Country:US
Mailing Address - Phone:949-439-1212
Mailing Address - Fax:
Practice Address - Street 1:1145 19TH ST NW STE 508
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3715
Practice Address - Country:US
Practice Address - Phone:202-826-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000289261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental