Provider Demographics
NPI:1437830585
Name:KOUROSH MEHRABIAN DDS & ASSOCIATES PC
Entity Type:Organization
Organization Name:KOUROSH MEHRABIAN DDS & ASSOCIATES PC
Other - Org Name:MARYLAND DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-667-7615
Mailing Address - Street 1:19731 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-1337
Mailing Address - Country:US
Mailing Address - Phone:301-528-5000
Mailing Address - Fax:301-528-0700
Practice Address - Street 1:19731 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-1337
Practice Address - Country:US
Practice Address - Phone:301-528-5000
Practice Address - Fax:301-528-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1154657344Medicaid