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General NPI Number Information
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NPI Number | 1265293732
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Entity Type | Organization
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Legal Business Name | MODERN DENTISTRY 1 LLC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 8352 RITCHIE HWY
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City | PASADENA
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State | MD
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Zip | 21122-3944
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Country | US
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Telephone | 410-647-3595
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Fax |
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Provider Business Mailing Address
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Address Line | 6044 LOGANWOOD DR
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City | ROCKVILLE
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State | MD
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Zip | 20852-3459
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AFSHIN NATEGHI
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Credential | DDS
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Telephone | 669-237-5910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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