Provider Demographics
NPI:1508911041
Name:BEN MANESH DDS PC IV
Entity Type:Organization
Organization Name:BEN MANESH DDS PC IV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMAYOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-987-5200
Mailing Address - Street 1:237 KENTLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5446
Mailing Address - Country:US
Mailing Address - Phone:301-987-5200
Mailing Address - Fax:
Practice Address - Street 1:237 KENTLANDS BLVD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5446
Practice Address - Country:US
Practice Address - Phone:301-987-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty