Provider Demographics
NPI:1629707492
Name:MONTGOMERY PEDIATRIC DENTAL PARTNERS, LLC
Entity Type:Organization
Organization Name:MONTGOMERY PEDIATRIC DENTAL PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHESHTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-752-8822
Mailing Address - Street 1:14955 SHADY GROVE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8723
Mailing Address - Country:US
Mailing Address - Phone:240-752-8822
Mailing Address - Fax:240-752-8821
Practice Address - Street 1:14955 SHADY GROVE RD STE 260
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8723
Practice Address - Country:US
Practice Address - Phone:240-752-8822
Practice Address - Fax:240-752-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty