Provider Demographics
NPI:1265293732
Name:MODERN DENTISTRY 1 LLC
Entity type:Organization
Organization Name:MODERN DENTISTRY 1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NATEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:669-237-5910
Mailing Address - Street 1:6044 LOGANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8352 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-3944
Practice Address - Country:US
Practice Address - Phone:410-647-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty