Provider Demographics
NPI:1790676617
Name:STOMADENT LIMITED
Entity type:Organization
Organization Name:STOMADENT LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODJAEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-505-9340
Mailing Address - Street 1:14808 PHYSICIANS LN STE 112
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14808 PHYSICIANS LN STE 112
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3905
Practice Address - Country:US
Practice Address - Phone:301-424-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental