1922431428 NPI number — DENTAL CENTER OF ASPEN HILL, LLC

Table of content: (NPI 1922431428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922431428 NPI number — DENTAL CENTER OF ASPEN HILL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL CENTER OF ASPEN HILL, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922431428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 BRICE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-580-6047
Provider Business Mailing Address Fax Number:
301-871-7300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13957 CONNECTICUT AVENUE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-871-6660
Provider Business Practice Location Address Fax Number:
301-871-7300
Provider Enumeration Date:
08/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ALLAFI
Authorized Official First Name:
CYRUS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-580-6047

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  14546 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 14981 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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