NPIMap

Organization Active NPI

Russell Park Dental Care, LLC

  • Dental Clinic/Center
  • Gaithersburg, MD
National Provider Identifier
1407474380
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
RUSSELL PARK DENTAL CARE, LLC
Practice address
963 Russell Ave Ste a
Gaithersburg, MD 20879-3287
Phone
(301) 284-8467
NPI assigned
Jul 8, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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

Authorized official

Name
Dr. Vigen Simchian, DDSNPI 1174845002
Title
Member
Phone
(301) 284-8467

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

963 Russell Ave Ste a
Gaithersburg, MD 20879-3287

Mailing address

963 Russell Ave Ste a
Gaithersburg, MD 20879-3287
Phone (301) 284-8467

National Provider Directory

National Provider Directory

Locations

963 Russell Ave
Ste A
Gaithersburg, MD 20879
Phone (301) 284-8467

Practitioners & affiliated clinicians

Practitioners 1

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": "1594166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594166400000",
    "number": "1407474380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "963 RUSSELL AVE STE A",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793287",
            "telephone_number": "301-284-8467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "963 RUSSELL AVE STE A",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793287",
            "telephone_number": "301-284-8467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL PARK DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-08",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A",
        "authorized_official_last_name": "SIMCHIAN",
        "authorized_official_first_name": "VIGEN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "301-284-8467",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 8, 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.