NPIMap

Organization Active NPI

Gaithersburg Modern Dentistry, LLC

Doing business as Gaithersburg Modern Dentistry

  • Dentist
  • Gaithersburg, MD
National Provider Identifier
1578242780
Registry record updated Jul 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
GAITHERSBURG MODERN DENTISTRY, LLC
Doing business as
Gaithersburg Modern Dentistry
Practice address
812 Muddy Branch Rd
Gaithersburg, MD 20878-2780
Phone
(240) 801-3138
Fax
(240) 821-5953
NPI assigned
Jul 14, 2023
Last updated
Jul 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2023

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

Authorized official

Name
Ali Shahrestani, DMD
Title
Owner
Phone
(240) 801-3138

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

812 Muddy Branch Rd
Gaithersburg, MD 20878-2780

Mailing address

PO Box 920050
Dallas, TX 75392-0050

Other names 1

  • GAITHERSBURG MODERN DENTISTRY Doing business as

National Provider Directory

National Provider Directory

Locations

812 Muddy Branch Rd
Gaithersburg, MD 20878
Phone (240) 801-3138

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689292800000",
    "number": "1578242780",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 MUDDY BRANCH RD",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208782780",
            "telephone_number": "240-801-3138",
            "fax_number": "240-821-5953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAITHERSBURG MODERN DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-14",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A",
        "authorized_official_last_name": "SHAHRESTANI",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-801-3138",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GAITHERSBURG MODERN DENTISTRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 14, 2023; 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.