Healthcare Provider Details

I. General information

NPI: 1265626873
Provider Name (Legal Business Name): SHEILA ESFANDIARI DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W EDMONSTON DR STE 205
ROCKVILLE MD
20852-1250
US

IV. Provider business mailing address

50 W EDMONSTON DR STE 205
ROCKVILLE MD
20852-1250
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-1401
  • Fax: 301-424-1402
Mailing address:
  • Phone: 301-424-1401
  • Fax: 301-424-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11800
License Number StateMD

VIII. Authorized Official

Name: DR. SHEILA ESFANDIARI
Title or Position: PRESIDENT
Credential: DDS
Phone: 301-424-1401