Provider Demographics
NPI:1144501677
Name:AKHAVAN MALAYERI, MINOO (DDS)
Entity type:Individual
Prefix:
First Name:MINOO
Middle Name:
Last Name:AKHAVAN MALAYERI
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 1:1613 HARVARD ST NW STE 108
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3710
Mailing Address - Country:US
Mailing Address - Phone:202-462-5227
Mailing Address - Fax:202-462-7445
Practice Address - Street 1:1613 HARVARD ST NW STE 108
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3710
Practice Address - Country:US
Practice Address - Phone:202-462-5227
Practice Address - Fax:202-462-7445
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150391223G0001X
VA04014132661223G0001X
DCDEN10010511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice