Pediatric Dental Care, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

11552 Issued in MD

Legal business name

PEDIATRIC DENTAL CARE, LLC

Practice address

1011 E Patrick St
Frederick, MD 21701-3119

Phone

(301) 360-9692

Fax

(301) 668-9692

NPI assigned

Jul 29, 2015

Organization subpart

No

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

Authorized official

Name

Fariba Paryavi, DDS

Title

Pediatric Dentist

Phone

(301) 360-9692

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438128000000",
    "number": "1639554876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 E PATRICK ST",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217013119",
            "telephone_number": "301-360-9692",
            "fax_number": "301-668-9692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 E PATRICK ST",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217013119",
            "telephone_number": "301-360-9692",
            "fax_number": "301-668-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-29",
        "last_updated": "2015-07-29",
        "status": "A",
        "authorized_official_last_name": "PARYAVI",
        "authorized_official_first_name": "FARIBA",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "301-360-9692",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "11552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.