Provider Demographics
NPI:1891845459
Name:BAGHAEI-RAD, MEHDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEHDY
Middle Name:
Last Name:BAGHAEI-RAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10122 RIVER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4900
Mailing Address - Country:US
Mailing Address - Phone:301-299-3993
Mailing Address - Fax:
Practice Address - Street 1:10122 RIVER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4900
Practice Address - Country:US
Practice Address - Phone:301-299-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics