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General NPI Number Information
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NPI Number | 1386219673
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Entity Type | Organization
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Legal Business Name | QODC PEDO LLC
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 845 QUINCE ORCHARD BLVD STE P
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1676
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Country | US
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Telephone | 301-527-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 845 QUINCE ORCHARD BLVD STE P
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1676
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Country | US
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Telephone | 301-527-2727
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMMAD MEHRAN ROUHANIAN
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Credential | DDS
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Telephone | 301-527-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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