Provider Demographics
NPI:1821392705
Name:NORTH BETHESDA DENTAL CARE
Entity Type:Organization
Organization Name:NORTH BETHESDA DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZEMZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:301-770-9007
Mailing Address - Street 1:11125 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE G2
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:301-770-9007
Mailing Address - Fax:301-770-9507
Practice Address - Street 1:11125 ROCKVILLE PIKE
Practice Address - Street 2:SUITE G2
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-770-9007
Practice Address - Fax:301-770-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11795302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization