Cyrus Farookh Mistry, M.D., D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

16286 Issued in MD

Practice address

6191 Executive Blvd
Rockville, MD 20852-3901

Phone

(301) 610-3918

Fax

(301) 610-3781

NPI assigned

Apr 11, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 28, 2018 through Nov 28, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Modern Oral & Facial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Rockville, MD
  • NPI 1902479025

  Single Specialty

  NPD Authorized official
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1134486491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6191 EXECUTIVE BLVD",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208523901",
            "telephone_number": "301-610-3918",
            "fax_number": "301-610-3781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6191 EXECUTIVE BLVD",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208523901",
            "telephone_number": "301-610-3918",
            "fax_number": "301-610-3781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISTRY",
        "first_name": "CYRUS",
        "middle_name": "FAROOKH",
        "credential": "M.D., D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-11",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MD",
            "license": "16286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@modernofs.com",
            "affiliation": "N",
            "address_1": "6191 Executive Blvd",
            "city": "Rockville",
            "state": "MD",
            "country_code": "US",
            "postal_code": "208523901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Supriya Mishra, M.D.
• Victoria Mislan
• John Joseph Mistretta, DDS
• Alicia T Mistry, MD
• Bhavana Mistry, DDS
• Breasia Mitchell Posey
• Alaishia Mitchell
• Amber Mitchell
• Anne Mitchell
• Aquiyah Mitchell

• Oral and Maxillofacial Surgery (Dentist) in Rockville, MD
• Providers in Rockville, MD by specialty
• Oral and Maxillofacial Surgery (Dentist) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.