Provider Demographics
NPI:1316622418
Name:SHAHRIARI, SHAHRIAR (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAHRIAR
Middle Name:
Last Name:SHAHRIARI
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 1:22905 MEADOW MIST RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-3325
Mailing Address - Country:US
Mailing Address - Phone:301-919-8353
Mailing Address - Fax:
Practice Address - Street 1:11251 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4556
Practice Address - Country:US
Practice Address - Phone:301-798-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist