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General NPI Number Information
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NPI Number | 1568832558
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Entity Type | Organization
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Legal Business Name | SEQUENCE ORTHODONTICS
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Dates
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Enumeration Date | 10/02/2015
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 603 POST OFFICE RD STE 109
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City | WALDORF
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State | MD
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Zip | 20602-1914
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Country | US
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Telephone | 617-599-0599
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Fax |
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Provider Business Mailing Address
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Address Line | 603 POST OFFICE RD STE 109
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City | WALDORF
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State | MD
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Zip | 20602-1914
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Country | US
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Telephone | 617-599-0599
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALIREZA OMID RAJAEI
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Credential | DDS
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Telephone | 617-599-0599
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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 | 13854
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 13854
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License Number State | MD
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