1528108214 NPI number — AESTHETIC & FAMILY DENTAL CARE

Table of content: (NPI 1528108214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528108214 NPI number — AESTHETIC & FAMILY DENTAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AESTHETIC & FAMILY DENTAL CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALLURE DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528108214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8170 MAPLE LAWN BLVD
Provider Second Line Business Mailing Address:
SUITE#150
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20759-2537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-456-0717
Provider Business Mailing Address Fax Number:
240-456-0719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8170 MAPLE LAWN BLVD
Provider Second Line Business Practice Location Address:
SUITE#150
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20759-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-456-0717
Provider Business Practice Location Address Fax Number:
240-456-0719
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZULFAGHARY
Authorized Official First Name:
MAHVASH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
240-456-0717

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  11926 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 256537 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 228939 . This is a "TRIGON VA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 903494 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: IB03TT . This is a "DENTAMAX" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 30396 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7458 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 930396 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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