Provider Demographics
NPI:1558487413
Name:MONTGOMERY VILLAGE DENTAL CTR
Entity Type:Organization
Organization Name:MONTGOMERY VILLAGE DENTAL CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NASELRI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-548-8888
Mailing Address - Street 1:18544 OFFICE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20886
Mailing Address - Country:US
Mailing Address - Phone:301-548-8888
Mailing Address - Fax:301-548-9037
Practice Address - Street 1:18544 OFFICE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20886
Practice Address - Country:US
Practice Address - Phone:301-548-8888
Practice Address - Fax:301-548-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty