Provider Demographics
NPI:1548392152
Name:MODEL DENTAL CLINIC
Entity type:Organization
Organization Name:MODEL DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROGHIEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ATAPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-730-6666
Mailing Address - Street 1:9520 BERGER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1554
Mailing Address - Country:US
Mailing Address - Phone:410-730-6666
Mailing Address - Fax:410-730-3501
Practice Address - Street 1:9520 BERGER RD STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1554
Practice Address - Country:US
Practice Address - Phone:410-730-6666
Practice Address - Fax:410-730-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty