Provider Demographics
NPI:1144880667
Name:R3 DENTAL GROUP LLC
Entity type:Organization
Organization Name:R3 DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-438-1200
Mailing Address - Street 1:14301 LAYHILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1937
Mailing Address - Country:US
Mailing Address - Phone:301-438-1200
Mailing Address - Fax:
Practice Address - Street 1:13097 WISTERIA DR STE 101
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2624
Practice Address - Country:US
Practice Address - Phone:301-540-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R3 DENTAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty