Provider Demographics
NPI:1053997361
Name:MOCO PEDIATRIC DENTISTS LLC
Entity type:Organization
Organization Name:MOCO PEDIATRIC DENTISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-846-7655
Mailing Address - Street 1:9210 CORPORATE BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6259
Mailing Address - Country:US
Mailing Address - Phone:917-846-6555
Mailing Address - Fax:
Practice Address - Street 1:9210 CORPORATE BLVD STE 430
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6259
Practice Address - Country:US
Practice Address - Phone:917-846-7655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty