Amal Rastogi, DMD, MSD, PHD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

14431 Issued in MD

Practice address

11855 Holly LN
Suite 106
Waldorf, MD 20601-3114

Phone

(301) 645-3100

Fax

(301) 885-0600

NPI assigned

Jul 20, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1216512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263945600000",
    "number": "1154586162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11855 HOLLY LN",
            "address_2": "SUITE 106",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013114",
            "telephone_number": "301-645-3100",
            "fax_number": "301-885-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11855 HOLLY LN",
            "address_2": "SUITE 106",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013114",
            "telephone_number": "301-645-3100",
            "fax_number": "301-885-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASTOGI",
        "first_name": "AMAL",
        "name_prefix": "Dr.",
        "credential": "DMD, MSD, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-20",
        "last_updated": "2010-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MD",
            "license": "14431",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "VA",
            "license": "0401412038",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Periodontics in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; 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.