Reza Nikookar
Dentist in Glenn Dale, MD. Individual provider (NPI-1).
NPI number1013783166
StatusActive
Last updated in NPPESNov 29, 2023
Details
- NPI
- 1013783166
- Entity type
- Individual (NPI-1)
- Name
- Reza Nikookar
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 29, 2023
- Certification date
- Nov 29, 2023
- Last updated
- Nov 29, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 18347 | MD | Yes |
| 1223G0001X | Dentist, General Practice | 18347 | MD |
Practice location
12150 Annapolis Rd Ste 301Glenn Dale, MD 20769-9183
Phone 773-875-0554
Mailing address
Po Box 7065Gaithersburg, MD 20898-7065
Phone 185-899-9668
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