MEDICARE: DENTAL SPOT, 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	:	1427883149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SPOT, LLC

Provider Business Mailing Address
First Line	:	6510 GARDENWICK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-2538
Country	:	US
Telephone Number	:	443-762-1470
Fax Number	:

Provider Business Practice Location Address
First Line	:	6210 PARK HEIGHTS AVE UNIT 104
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3626
Country	:	US
Telephone Number	:	443-583-0005
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAYAM NOURMAND
Credential	:
Telephone Number	:	443-762-1470

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	09/03/2024

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Directions to “DENTAL SPOT, LLC ” Practice Location

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