=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790676617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STOMADENT LIMITED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2025
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14808 PHYSICIANS LN STE 112
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-3905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-424-0606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14808 PHYSICIANS LN STE 112
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-3905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SANJAR KHODJAEV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-505-9340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------