Provider Demographics
NPI:1679370381
Name:MIDTOWN DENTAAL CARE,LLC
Entity type:Organization
Organization Name:MIDTOWN DENTAAL CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-837-8669
Mailing Address - Street 1:7625 MAPLE LAWN BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2565
Mailing Address - Country:US
Mailing Address - Phone:301-244-0915
Mailing Address - Fax:
Practice Address - Street 1:7625 MAPLE LAWN BLVD STE 240
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2565
Practice Address - Country:US
Practice Address - Phone:301-244-0915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty