Provider Demographics
NPI:1124849278
Name:GAITHERSBURG COMPLETE DENTAL CARE
Entity type:Organization
Organization Name:GAITHERSBURG COMPLETE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOOKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-448-0236
Mailing Address - Street 1:8 RUSSELL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16220 FREDERICK RD STE 400
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4025
Practice Address - Country:US
Practice Address - Phone:301-448-0236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental