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General NPI Number Information
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NPI Number | 1508166562
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Entity Type | Organization
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Legal Business Name | CENTER FOR ORAL AND MAXILLOFACIAL RECONSTRUCTIVE SURGERY
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 3001 HOSPITAL DR
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City | CHEVERLY
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State | MD
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Zip | 20785-1189
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Country | US
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Telephone | 973-223-2678
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 MASSACHUSETTS AVE NW SUITE 116
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City | WASHINGTON
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State | DC
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Zip | 20016-5800
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Country | US
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Telephone | 973-223-2678
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALI PASHAPOUR
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Credential |
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Telephone | 973-223-2678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401411854
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 14010
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License Number State | MD
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