Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 15696 | MD |
N | 122300000X | Dentist | DEN1001440 | DC |
Y | 1223G0001X | General Practice | 15696 | MD |
Y | 213EG0000X | General Practice | 15696 | MD |
NPI | 1003218009 |
---|---|
Provider Name | Dr. Reza Keshmiri |
First Address | Germantown, MD 20874-6124 |
Second Address | Germantown, MD 20874-6124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2014 |
Last Update Date | 12/11/2015 |