Provider Demographics
NPI:1649754482
Name:GREATER MARYLAND ENDODONTICS, LLC
Entity Type:Organization
Organization Name:GREATER MARYLAND ENDODONTICS, LLC
Other - Org Name:TAKOMA PARK ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRYAR
Authorized Official - Middle Name:NASIR
Authorized Official - Last Name:KHALIQ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-275-0833
Mailing Address - Street 1:2045 UNIVERSITY BLVD E STE 204
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2045 UNIVERSITY BLVD E STE 204
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4137
Practice Address - Country:US
Practice Address - Phone:240-842-9980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty