Provider Demographics
NPI:1750126892
Name:SIDHOM, NADER (DMD)
Entity type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:SIDHOM
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PATTERSON ST NE APT 1223
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-8289
Mailing Address - Country:US
Mailing Address - Phone:703-883-7777
Mailing Address - Fax:
Practice Address - Street 1:9500 LIVINGSTON RD STE 105
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4973
Practice Address - Country:US
Practice Address - Phone:301-203-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN2000400122300000X
MD18443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist