Provider Demographics
NPI:1881979813
Name:PARTOVI-TABAR, PARISA (DDS)
Entity type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:PARTOVI-TABAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PARISA
Other - Middle Name:
Other - Last Name:TABAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:19644 CLUB HOUSE RD
Mailing Address - Street 2:SUITE 810
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3047
Mailing Address - Country:US
Mailing Address - Phone:301-740-7500
Mailing Address - Fax:301-740-7512
Practice Address - Street 1:19644 CLUB HOUSE RD
Practice Address - Street 2:SUITE 810
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3047
Practice Address - Country:US
Practice Address - Phone:301-740-7500
Practice Address - Fax:301-740-7512
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice