=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619244852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROUHANIAN DENTAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2011
-----------------------------------------------------
Last Update Date | 02/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 QUINCE ORCHARD BLVD STE H
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-527-2727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 845 QUINCE ORCHARD BLVD STE H
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20878-1676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-527-2727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MOHAMMAD MEHRAN ROUHANIAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 301-637-9744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------