# FATEMI FAMILY DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033565528
- **Authorized official:** MOHAMMAD FATEMI DDS (DENTIST)
- **Authorized official phone:** (301) 740-2686

## Contact information

- **Practice address:** 604 S FREDERICK AVE, \#209, GAITHERSBURG, MD 20877-1275
- **Practice address phone:** (301) 740-2686
- **Mailing address:** 64 SOUTH FREDERICK AVE \#209, GAITHERSBURG, MD 20877
- **Mailing address phone:** (301) 740-2686
- **Mailing address fax:** (240) 238-2921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | 11720 | MD | Yes |

## Other

- **Enumeration date:** 05/13/2016
- **Last updated:** 05/13/2016