MEDICARE: OMEGA DENTAL GROUP LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1366255424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	806 W DIAMOND AVE STE 330
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-1470
Country	:	US
Telephone Number	:	301-838-9300
Fax Number	:	301-838-9304

Provider Business Practice Location Address
First Line	:	806 W DIAMOND AVE STE 330
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-1470
Country	:	US
Telephone Number	:	301-838-9300
Fax Number	:	301-838-9304

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. DIPTY MAHAJAN
Credential	:	DMD
Telephone Number	:	240-543-5495

Provider Enumeration Date	:	01/30/2025
Last Update Date	:	01/30/2025

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