Provider Demographics
NPI:1215177324
Name:NASSERI, SIAMAK (DMD)
Entity type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:NASSERI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 HARVARD ST NW STE 108
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3710
Mailing Address - Country:US
Mailing Address - Phone:202-462-5227
Mailing Address - Fax:
Practice Address - Street 1:1613 HARVARD ST NW STE 108
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3710
Practice Address - Country:US
Practice Address - Phone:202-462-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51204122300000X
DCDEN56461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist