Healthcare Provider Details

I. General information

NPI: 1700010709
Provider Name (Legal Business Name): SACHIN RASTOGI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 MALCOLM RD SUITE # 300
CLINTON MD
20735-1734
US

IV. Provider business mailing address

7905 MALCOLM RD SUITE # 300
CLINTON MD
20735-1734
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14405
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number56602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: