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General NPI Number Information
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NPI Number | 1669764007
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL GROUP OF GERMANTOWN
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 13097 WISTERIA DR STE 101
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City | GERMANTOWN
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State | MD
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Zip | 20874-2624
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Country | US
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Telephone | 301-540-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 13097 WISTERIA DR STE 101
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City | GERMANTOWN
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State | MD
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Zip | 20874-2624
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | AMIR TOFIGH
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Credential |
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Telephone | 301-540-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11510
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License Number State | MD
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