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General NPI Number Information
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NPI Number | 1568021012
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Entity Type | Organization
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Legal Business Name | ENDODONTICS OF GAITHERSBURG, LLC
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Dates
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Enumeration Date | 06/09/2019
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Last Update Date | 06/09/2019
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Provider Practice Location Address
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Address Line | 847 QUINCE ORCHARD BLVD STE G
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1677
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Country | US
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Telephone | 301-527-0303
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Fax | 301-527-0404
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Provider Business Mailing Address
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Address Line | 847 QUINCE ORCHARD BLVD STE G
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1677
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Country | US
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Telephone | 301-527-0303
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Fax | 301-527-0404
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Authorized Official
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Title or Position | ENDODONTIST/OWNER
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Name | DR. ALI REZA EGHTESADI
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Credential | DDS
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Telephone | 301-527-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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