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General NPI Number Information
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NPI Number | 1366560716
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Entity Type | Organization
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Legal Business Name | FARIBA RAFIZADEH, D.M.D. P.A.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 902 WIND RIVER LN STE 204
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1977
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Country | US
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Telephone | 301-948-5656
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Fax | 301-519-9164
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Provider Business Mailing Address
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Address Line | 902 WIND RIVER LN STE 204
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1977
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Country | US
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Telephone | 301-948-5656
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Fax | 301-519-9164
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. FARIBA RAFIZADEH
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Credential | D.M.D.
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Telephone | 301-948-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12428
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License Number State | MD
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