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General NPI Number Information
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NPI Number | 1932489523
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Entity Type | Organization
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Legal Business Name | DENTAL & PROSTHODONTICS REHAB INC.
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 3460 OLD WASHINGTON RD SUITE 102
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City | WALDORF
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State | MD
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Zip | 20602-3240
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Country | US
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Telephone | 301-638-1420
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Fax | 301-638-1493
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Provider Business Mailing Address
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Address Line | 3460 OLD WASHINGTON RD SUITE 102
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City | WALDORF
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State | MD
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Zip | 20602-3240
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Country | US
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Telephone | 301-638-1420
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Fax | 301-638-1493
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RADI MASRI
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Credential | D.D.S., M.S., PH.D.
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Telephone | 301-638-1420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 13015
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License Number State | MD
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