Provider Demographics
NPI:1740328376
Name:ASKARI, MARTY MEHRDAD
Entity type:Individual
Prefix:DR
First Name:MARTY
Middle Name:MEHRDAD
Last Name:ASKARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 OLD FARM DR
Mailing Address - Street 2:SUITE #C
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5400
Mailing Address - Country:US
Mailing Address - Phone:301-663-1144
Mailing Address - Fax:
Practice Address - Street 1:2090 OLD FARM DR
Practice Address - Street 2:SUITE #C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-5400
Practice Address - Country:US
Practice Address - Phone:301-663-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice