Healthcare Provider Details

I. General information

NPI: 1649431735
Provider Name (Legal Business Name): DENTAL ASSOCIATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 E WEST HWY STE 400
HYATTSVILLE MD
20782-2014
US

IV. Provider business mailing address

1019 FARM HAVEN DR
ROCKVILLE MD
20852-4247
US

V. Phone/Fax

Practice location:
  • Phone: 301-454-0300
  • Fax:
Mailing address:
  • Phone: 301-370-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number13890
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number11486
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11510
License Number StateMD

VIII. Authorized Official

Name: RAHIM TOFIGH
Title or Position: DENTIST
Credential:
Phone: 301-370-9151