Provider Demographics
NPI:1083687404
Name:GERMANTOWN DENTAL SERVICE
Entity Type:Organization
Organization Name:GERMANTOWN DENTAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:RIFFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:AJMSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-972-5000
Mailing Address - Street 1:19513 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:301-972-5000
Mailing Address - Fax:301-972-9538
Practice Address - Street 1:19513 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MO
Practice Address - Zip Code:20874
Practice Address - Country:US
Practice Address - Phone:301-972-5000
Practice Address - Fax:301-972-9538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty