Provider Demographics
NPI:1427051424
Name:MATIN, MADJID (DMD)
Entity type:Individual
Prefix:DR
First Name:MADJID
Middle Name:
Last Name:MATIN
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 1:5530 WISCONSIN AVE
Mailing Address - Street 2:STE 1110
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4330
Mailing Address - Country:US
Mailing Address - Phone:301-656-6424
Mailing Address - Fax:301-656-6425
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:STE 1110
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4330
Practice Address - Country:US
Practice Address - Phone:301-656-6424
Practice Address - Fax:301-656-6425
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics