NPIMap

Organization Active NPI

R3 Dental Group LLC

Doing business as Lakeside Dental

  • Dentist
  • Gaithersburg, MD
National Provider Identifier
1013515840
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
R3 DENTAL GROUP LLC
Doing business as
Lakeside Dental
Practice address
100 Lakeforest Blvd Ste 620
Gaithersburg, MD 20877-6203
Phone
(301) 990-7778
NPI assigned
Oct 14, 2020
Last updated
Oct 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alireza RajaeiNPI 1982743068
Title
Owner
Phone
(301) 438-1200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

100 Lakeforest Blvd Ste 620
Gaithersburg, MD 20877-6203

Mailing address

100 Lakeforest Blvd Ste 620
Gaithersburg, MD 20877-6203
Phone (301) 990-7778

Other names 1

  • Lakeside Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cedar Smiles7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1013515840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 LAKEFOREST BLVD STE 620",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208776203",
            "telephone_number": "301-990-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LAKEFOREST BLVD STE 620",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208776203",
            "telephone_number": "301-990-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R3 DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A",
        "authorized_official_last_name": "RAJAEI",
        "authorized_official_first_name": "ALIREZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-438-1200"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.