=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194547356
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A R SEDIGHIAN, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2024
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9005 CHEVROLET DR STE 1
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21042-4030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-465-3021
-----------------------------------------------------
Fax | 410-461-8694
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9005 CHEVROLET DR STE 1
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21042-4030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-465-3021
-----------------------------------------------------
Fax | 410-461-8694
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ALI R SEDIGHIAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 410-979-7980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------