Provider Demographics
NPI:1013515840
Name:R3 DENTAL GROUP LLC
Entity Type:Organization
Organization Name:R3 DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-438-1200
Mailing Address - Street 1:100 LAKEFOREST BLVD STE 620
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-6203
Mailing Address - Country:US
Mailing Address - Phone:301-990-7778
Mailing Address - Fax:
Practice Address - Street 1:100 LAKEFOREST BLVD STE 620
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-6203
Practice Address - Country:US
Practice Address - Phone:301-990-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty