Provider Demographics
NPI:1215390596
Name:NIMA RAOUFINIA DDS LLC
Entity Type:Organization
Organization Name:NIMA RAOUFINIA DDS LLC
Other - Org Name:SILVER SPRING COSMETIC DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAOUFINIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-945-2504
Mailing Address - Street 1:2300 24TH RD S
Mailing Address - Street 2:APT 1153
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2637
Mailing Address - Country:US
Mailing Address - Phone:703-945-2504
Mailing Address - Fax:
Practice Address - Street 1:8726 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3601
Practice Address - Country:US
Practice Address - Phone:301-565-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty