Provider Demographics
NPI:1366740706
Name:HEDYEH ATASHBAR DDS LLC
Entity type:Organization
Organization Name:HEDYEH ATASHBAR DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEDYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ATASHBAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-495-3000
Mailing Address - Street 1:1109 SPRING ST
Mailing Address - Street 2:SUITE 702
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4002
Mailing Address - Country:US
Mailing Address - Phone:301-495-3000
Mailing Address - Fax:301-495-0963
Practice Address - Street 1:1109 SPRING ST
Practice Address - Street 2:SUITE 702
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4002
Practice Address - Country:US
Practice Address - Phone:301-495-3000
Practice Address - Fax:301-495-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9220303Medicaid