MEDICARE: MARYLAND DENTAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center
2	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154657344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND DENTAL CENTER

Provider Business Mailing Address
First Line	:	8120 FENTON ST
Second Line	:	SUITE 100
City	:	SILVER SPRING
State	:	MD
Zip	:	20910
Country	:	US
Telephone Number	:	240-667-7615
Fax Number	:	301-608-9331

Provider Business Practice Location Address
First Line	:	8120 FENTON ST
Second Line	:	SUITE 100
City	:	SILVER SPRING
State	:	MD
Zip	:	20910
Country	:	US
Telephone Number	:	301-608-9800
Fax Number	:	301-608-9331

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KOUROSH MEHRABIAN
Credential	:	DDS
Telephone Number	:	301-608-9800

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	05/24/2024

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Directions to “MARYLAND DENTAL CENTER ” Practice Location

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