Provider Demographics
NPI:1407303787
Name:CHEVY CHASE DENTAL INC.
Entity Type:Organization
Organization Name:CHEVY CHASE DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-652-0909
Mailing Address - Street 1:4708 BRADLEY BLVD
Mailing Address - Street 2:SUITE T2
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6320
Mailing Address - Country:US
Mailing Address - Phone:301-652-0909
Mailing Address - Fax:301-652-2993
Practice Address - Street 1:4708 BRADLEY BLVD
Practice Address - Street 2:SUITE T2
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6320
Practice Address - Country:US
Practice Address - Phone:301-652-0909
Practice Address - Fax:301-652-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11890261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000207100Medicaid
DC038339200Medicaid