Provider Demographics
NPI:1659708154
Name:ROYAL CARE DENTISTRY
Entity Type:Organization
Organization Name:ROYAL CARE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POURAHMAD-HAGHIGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-258-7477
Mailing Address - Street 1:12116 DARNESTOWN RD STE L1
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2227
Mailing Address - Country:US
Mailing Address - Phone:301-258-7477
Mailing Address - Fax:
Practice Address - Street 1:12116 DARNESTOWN RD STE L1
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2227
Practice Address - Country:US
Practice Address - Phone:301-258-7477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty