Provider Demographics
NPI:1639689201
Name:ALPHA DENTAL CENTER
Entity Type:Organization
Organization Name:ALPHA DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ASGARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:443-207-8455
Mailing Address - Street 1:300 E PULASKI HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6737
Mailing Address - Country:US
Mailing Address - Phone:443-207-8455
Mailing Address - Fax:443-485-6584
Practice Address - Street 1:300 E PULASKI HWY STE 102
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6737
Practice Address - Country:US
Practice Address - Phone:443-207-8455
Practice Address - Fax:443-485-6584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16186261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental