Provider Demographics
NPI:1417298472
Name:R3 DENTAL GROUP LLC
Entity Type:Organization
Organization Name:R3 DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:OMID
Authorized Official - Last Name:RAJAEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-599-0599
Mailing Address - Street 1:14301 LAYHILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1937
Mailing Address - Country:US
Mailing Address - Phone:301-438-1200
Mailing Address - Fax:
Practice Address - Street 1:14301 LAYHILL RD STE 102
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1937
Practice Address - Country:US
Practice Address - Phone:301-438-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
MD138541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty