Provider Demographics
NPI:1922419159
Name:FORGHANI, DDS, PA
Entity Type:Organization
Organization Name:FORGHANI, DDS, PA
Other - Org Name:MODERN SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:FORGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-292-4740
Mailing Address - Street 1:130 ROLLINS AVENUE
Mailing Address - Street 2:SUITE H2
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:240-292-4740
Mailing Address - Fax:
Practice Address - Street 1:130 ROLLINS AVE
Practice Address - Street 2:SUITE H2
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4093
Practice Address - Country:US
Practice Address - Phone:240-292-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty