Provider Demographics
NPI:1356775613
Name:SAMADNEJAD, FARSHAD (DDS)
Entity type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:SAMADNEJAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:SAMAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5405 TUCKERMAN LN
Mailing Address - Street 2:APT. # 453
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-7301
Mailing Address - Country:US
Mailing Address - Phone:410-530-1522
Mailing Address - Fax:
Practice Address - Street 1:5405 TUCKERMAN LN
Practice Address - Street 2:APT. # 453
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-7301
Practice Address - Country:US
Practice Address - Phone:410-530-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15535122300000X
VA0401414153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist