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General NPI Number Information
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NPI Number | 1639554876
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL CARE, LLC
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 1011 E PATRICK ST
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City | FREDERICK
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State | MD
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Zip | 21701-3119
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Country | US
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Telephone | 301-360-9692
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Fax | 301-668-9692
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Provider Business Mailing Address
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Address Line | 1011 E PATRICK ST
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City | FREDERICK
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State | MD
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Zip | 21701-3119
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Country | US
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Telephone | 301-360-9692
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Fax | 301-668-9692
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | FARIBA PARYAVI
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Credential | DDS
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Telephone | 301-360-9692
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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 | 11552
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License Number State | MD
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