Provider Demographics
NPI:1508523556
Name:HADI SICHANI, MONIREH (DDS)
Entity type:Individual
Prefix:
First Name:MONIREH
Middle Name:
Last Name:HADI SICHANI
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 1:10316 ROCKVILLE PIKE APT 201
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3317
Mailing Address - Country:US
Mailing Address - Phone:240-505-4265
Mailing Address - Fax:
Practice Address - Street 1:230 W DARES BEACH RD STE 107
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3151
Practice Address - Country:US
Practice Address - Phone:410-535-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN200019991223G0001X
MD181951223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice