Provider Demographics
NPI:1144392812
Name:STALEY-NEITHER, NEKIA A (DDS)
Entity type:Individual
Prefix:DR
First Name:NEKIA
Middle Name:A
Last Name:STALEY-NEITHER
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 1:8700 CENTRAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4861
Mailing Address - Country:US
Mailing Address - Phone:240-501-4915
Mailing Address - Fax:301-735-3062
Practice Address - Street 1:8700 CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4861
Practice Address - Country:US
Practice Address - Phone:240-501-4915
Practice Address - Fax:844-623-4307
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10004341223G0001X
MD134581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036291500Medicaid