Provider Demographics
NPI:1942767074
Name:MY FREDERICK DENTIST LLC
Entity Type:Organization
Organization Name:MY FREDERICK DENTIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-580-6047
Mailing Address - Street 1:2100 OLD FARM DR # 1-B
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-9494
Mailing Address - Country:US
Mailing Address - Phone:301-698-9552
Mailing Address - Fax:
Practice Address - Street 1:2100 OLD FARM DR # 1-B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9494
Practice Address - Country:US
Practice Address - Phone:301-698-9552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty