Individual
REZA NIKOOKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12150 ANNAPOLIS RD STE 301, GLENN DALE, MD 20769-9183
(773) 875-0554
Mailing address
PO BOX 7065, GAITHERSBURG, MD 20898-7065
(185) 899-9668
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18347
MD
1223G0001X
General Practice Dentistry
18347
MD
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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