1831656826 NPI number — KIDZ & FAMILY DENTAL CENTER LLC

Table of content: (NPI 1831656826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831656826 NPI number — KIDZ & FAMILY DENTAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDZ & FAMILY DENTAL CENTER LLC
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:
Provider Other Organization Name Type Code:
6
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:
1831656826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11933 GEORGIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-200-8015
Provider Business Mailing Address Fax Number:
240-833-2558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 HOLTON LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAKOMA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20912-7510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-200-8015
Provider Business Practice Location Address Fax Number:
240-833-2558
Provider Enumeration Date:
02/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
NEMATI
Authorized Official First Name:
PARISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-200-8015

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com