Provider Demographics
NPI:1851867527
Name:SHAHRAM MODARRES PC
Entity Type:Organization
Organization Name:SHAHRAM MODARRES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MODARRES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-816-9400
Mailing Address - Street 1:5822 HUBBARD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4818
Mailing Address - Country:US
Mailing Address - Phone:301-816-9400
Mailing Address - Fax:301-770-9263
Practice Address - Street 1:5822 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4818
Practice Address - Country:US
Practice Address - Phone:301-816-9400
Practice Address - Fax:301-770-9263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental