Provider Demographics
NPI:1619477726
Name:GREENBELT FAMILY DENTAL GROUPS
Entity Type:Organization
Organization Name:GREENBELT FAMILY DENTAL GROUPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:TOFIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-219-7286
Mailing Address - Street 1:7327 HANOVER PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7500 HANOVER PKWY STE 106
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2011
Practice Address - Country:US
Practice Address - Phone:301-474-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD154531223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD123-45-6780Medicaid