Provider Demographics
NPI:1518257245
Name:SHAZAAD ALLY DDS, & ASSOCIATES LLC
Entity Type:Organization
Organization Name:SHAZAAD ALLY DDS, & ASSOCIATES LLC
Other - Org Name:CHOICE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAZAAD
Authorized Official - Middle Name:I
Authorized Official - Last Name:ALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-562-6020
Mailing Address - Street 1:8501 COLESVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3322
Mailing Address - Country:US
Mailing Address - Phone:301-560-6020
Mailing Address - Fax:301-562-6024
Practice Address - Street 1:8501 COLESVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3322
Practice Address - Country:US
Practice Address - Phone:301-560-6020
Practice Address - Fax:301-562-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022744700Medicaid