Provider Demographics
NPI:1346307261
Name:P. GOLESTANI DDS, LLC
Entity Type:Organization
Organization Name:P. GOLESTANI DDS, LLC
Other - Org Name:CENTURY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARASTOO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLESTANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-972-1600
Mailing Address - Street 1:20010 CENTURY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1115
Mailing Address - Country:US
Mailing Address - Phone:301-972-1600
Mailing Address - Fax:301-972-3644
Practice Address - Street 1:20010 CENTURY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1115
Practice Address - Country:US
Practice Address - Phone:301-972-1600
Practice Address - Fax:301-972-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty