Provider Demographics
NPI:1104282201
Name:BEHNAZ YALDA DMD PC
Entity type:Organization
Organization Name:BEHNAZ YALDA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:YALDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-926-0691
Mailing Address - Street 1:803 RUSSELL AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3584
Mailing Address - Country:US
Mailing Address - Phone:301-926-0691
Mailing Address - Fax:
Practice Address - Street 1:803 RUSSELL AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3584
Practice Address - Country:US
Practice Address - Phone:301-926-0691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty