Provider Demographics
NPI:1770542714
Name:DAFTARY, NEIL DINESH (DMD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:DINESH
Last Name:DAFTARY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 RUSSELL AVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3584
Mailing Address - Country:US
Mailing Address - Phone:301-330-8787
Mailing Address - Fax:301-330-9734
Practice Address - Street 1:803 RUSSELL AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3584
Practice Address - Country:US
Practice Address - Phone:301-330-8787
Practice Address - Fax:301-330-9734
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice