Provider Demographics
NPI:1356476394
Name:M&R DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:M&R DENTAL ASSOCIATES
Other - Org Name:RANDOLPH ENDODONTICS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:GUNRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-384-9800
Mailing Address - Street 1:512 E RANDOLPH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3274
Mailing Address - Country:US
Mailing Address - Phone:301-384-9800
Mailing Address - Fax:
Practice Address - Street 1:512 E RANDOLPH RD
Practice Address - Street 2:SUITE A
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3274
Practice Address - Country:US
Practice Address - Phone:301-384-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD69221223E0200X
MD124591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty