Provider Demographics
NPI:1649431735
Name:DENTAL ASSOCIATE
Entity type:Organization
Organization Name:DENTAL ASSOCIATE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TOFIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-370-9151
Mailing Address - Street 1:1019 FARM HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4247
Mailing Address - Country:US
Mailing Address - Phone:301-370-9151
Mailing Address - Fax:
Practice Address - Street 1:3600 E WEST HWY STE 400
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2014
Practice Address - Country:US
Practice Address - Phone:301-454-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13890122300000X
MD114861223P0700X
MD115101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty