Provider Demographics
NPI:1396416566
Name:PLATINUM DENTAL GROUP, LLC
Entity type:Organization
Organization Name:PLATINUM DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-540-4425
Mailing Address - Street 1:19512 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5200
Mailing Address - Country:US
Mailing Address - Phone:301-540-4425
Mailing Address - Fax:301-540-2861
Practice Address - Street 1:19512 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5200
Practice Address - Country:US
Practice Address - Phone:301-540-4425
Practice Address - Fax:301-540-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty