Healthcare Provider Details

I. General information

NPI: 1053997361
Provider Name (Legal Business Name): MOCO PEDIATRIC DENTISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9210 CORPORATE BLVD STE 430
ROCKVILLE MD
20850-6259
US

IV. Provider business mailing address

9210 CORPORATE BLVD STE 430
ROCKVILLE MD
20850-6259
US

V. Phone/Fax

Practice location:
  • Phone: 917-846-7655
  • Fax:
Mailing address:
  • Phone: 917-846-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWIN ZAGHI
Title or Position: OWNER
Credential: DMD
Phone: 917-846-7655