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General NPI Number Information
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NPI Number | 1720969587
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Entity Type | Organization
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Legal Business Name | WALDORF ORAL SURGERY LLC
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 603 POST OFFICE RD STE 110
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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 | 301-843-8303
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Fax |
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Provider Business Mailing Address
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Address Line | 603 POST OFFICE RD STE 110
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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 | 301-843-8303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALIREZA RAJAEI
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Credential | DDS
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Telephone | 301-843-8303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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