Healthcare Provider Details

I. General information

NPI: 1568891141
Provider Name (Legal Business Name): EFTEKHAR A HASSANI,DDS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 RANDOLPH RD STE 205
ROCKVILLE MD
20852-2261
US

IV. Provider business mailing address

4701 RANDOLPH RD STE 205
ROCKVILLE MD
20852-2261
US

V. Phone/Fax

Practice location:
  • Phone: 301-230-2216
  • Fax:
Mailing address:
  • Phone: 301-230-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12040
License Number StateMD

VIII. Authorized Official

Name: EFTEKHAR ALSADAT HASSANI
Title or Position: OWNER
Credential: DDS
Phone: 301-230-2216