Provider Demographics
NPI:1497337125
Name:PRP DENTAL LLC
Entity Type:Organization
Organization Name:PRP DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHILA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-669-1572
Mailing Address - Street 1:1522 POINTER RIDGE PL STE E
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1875
Mailing Address - Country:US
Mailing Address - Phone:301-249-1102
Mailing Address - Fax:
Practice Address - Street 1:1522 POINTER RIDGE PL STE E
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1875
Practice Address - Country:US
Practice Address - Phone:301-249-1102
Practice Address - Fax:301-249-3258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty