NPIMap

Organization Active NPI

Olney Modern Dentistry, LLC

  • General Practice Dentistry
  • Olney, MD
National Provider Identifier
1316671019
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
OLNEY MODERN DENTISTRY, LLC
Doing business as
Olney Modern Dentistry
Practice address
3130 Olney Sandy Spring Rd
Olney, MD 20832-1408
Phone
(240) 665-5485
Fax
(240) 667-7024
NPI assigned
Jul 11, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Authorized official

Name
Ali Shahrestani, DMD
Title
Owner Doctor
Phone
(240) 665-5485

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3130 Olney Sandy Spring Rd
Olney, MD 20832-1408

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8890

Other names 1

  • Olney Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

3130 Olney Sandy Spring Rd
Olney, MD 20832
Phone (240) 665-5485

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1316671019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 OLNEY SANDY SPRING RD",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208321408",
            "telephone_number": "240-665-5485",
            "fax_number": "240-667-7024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLNEY MODERN DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-11",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "SHAHRESTANI",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "240-665-5485",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olney Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olney, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; 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.