Healthcare Provider Details

I. General information

NPI: 1366958654
Provider Name (Legal Business Name): PCD ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11904-D DARNESTOWN ROAD
NORTH POTOMAC MD
20878
US

IV. Provider business mailing address

11904-D DARNESTOWN ROAD
NORTH POTOMAC MD
20878
US

V. Phone/Fax

Practice location:
  • Phone: 240-683-8040
  • Fax: 240-683-8041
Mailing address:
  • Phone: 240-683-8040
  • Fax: 240-683-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. FARIBA PARYAVI
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 240-683-8040