Provider Demographics
NPI:1386124840
Name:SADEGHLO, BITA (DDS)
Entity type:Individual
Prefix:DR
First Name:BITA
Middle Name:
Last Name:SADEGHLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8913 WOODYARD RD STE B
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4257
Mailing Address - Country:US
Mailing Address - Phone:301-363-2336
Mailing Address - Fax:
Practice Address - Street 1:8913 WOODYARD RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4257
Practice Address - Country:US
Practice Address - Phone:301-363-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD165401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice