Provider Demographics
NPI:1932489523
Name:DENTAL & PROSTHODONTICS REHAB INC.
Entity Type:Organization
Organization Name:DENTAL & PROSTHODONTICS REHAB INC.
Other - Org Name:WALDORF COSMETIC & IMPLANT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RADI
Authorized Official - Middle Name:
Authorized Official - Last Name:MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PHD
Authorized Official - Phone:301-638-1420
Mailing Address - Street 1:3460 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3240
Mailing Address - Country:US
Mailing Address - Phone:301-638-1420
Mailing Address - Fax:301-638-1493
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3240
Practice Address - Country:US
Practice Address - Phone:301-638-1420
Practice Address - Fax:301-638-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13015261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental