NPIMap

Organization Active NPI

Gaithersburg Dental Associate PA

  • General Practice Dentistry
  • Gaithersburg, MD
National Provider Identifier
1073654133
Registry record updated Apr 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13266 Issued in MD
Legal business name
GAITHERSBURG DENTAL ASSOCIATE PA
Doing business as
Githersburg Dental Associates
Practice address
8 Russell Ave
Suite 104
Gaithersburg, MD 20877-2966
Phone
(301) 869-2500
Fax
(301) 926-7655
NPI assigned
Feb 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2019

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

Authorized official

Name
Dr. Mandana Goodarzi Logmanni, D.D.S.
Title
President
Phone
(301) 869-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 13266 MD Primary

Addresses

Primary practice location

8 Russell Ave
Suite 104
Gaithersburg, MD 20877-2966

Mailing address

8 Russell Ave
Suite 104
Gaithersburg, MD 20877-2966
Phone (301) 869-2500

Other names 2

  • Githersburg Dental Associates Doing business as
  • Logmanni Dental Associates Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Gaithersburg Dental Associate PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1171065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1073654133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 RUSSELL AVE",
            "address_2": "SUITE 104",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772966",
            "telephone_number": "301-869-2500",
            "fax_number": "301-926-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 RUSSELL AVE",
            "address_2": "SUITE 104",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772966",
            "telephone_number": "301-869-2500",
            "fax_number": "301-926-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAITHERSBURG DENTAL ASSOCIATE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-10",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "LOGMANNI",
        "authorized_official_first_name": "MANDANA",
        "authorized_official_middle_name": "GOODARZI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-869-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "13266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Githersburg Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Githersburg Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Logmanni Dental Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Apr 23, 2019; 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.