Provider Demographics
NPI:1528108214
Name:AESTHETIC & FAMILY DENTAL CARE
Entity type:Organization
Organization Name:AESTHETIC & FAMILY DENTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHVASH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZULFAGHARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-456-0717
Mailing Address - Street 1:8170 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE#150
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2537
Mailing Address - Country:US
Mailing Address - Phone:240-456-0717
Mailing Address - Fax:240-456-0719
Practice Address - Street 1:8170 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE#150
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2537
Practice Address - Country:US
Practice Address - Phone:240-456-0717
Practice Address - Fax:240-456-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD256537OtherMAMSI
MD228939OtherTRIGON VA
MD903494OtherUNITED CONCORDIA
MDIB03TTOtherDENTAMAX
MD30396OtherAETNA HMO
MD7458OtherBCBS
MD930396OtherAETNA PPO