Provider Demographics
NPI:1982964490
Name:SHATERGHOLI, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SHATERGHOLI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:SHATERGHOLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:215 RIDGEPOINT PLACE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:443-610-6652
Mailing Address - Fax:301-474-1110
Practice Address - Street 1:7600 HANOVER PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-474-1110
Practice Address - Fax:301-474-1008
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist