R3 Dental Group LLC
Dentist in Gaithersburg, MD. Organization (NPI-2).
NPI number1013515840
StatusActive
Last updated in NPPESOct 14, 2020
Details
- NPI
- 1013515840
- Entity type
- Organization (NPI-2)
- Legal business name
- R3 Dental Group LLC
- Organization subpart
- No
- Enumeration date
- Oct 14, 2020
- Certification date
- Oct 14, 2020
- Last updated
- Oct 14, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | – | – | Yes |
Other names
- Lakeside Dental (Doing Business As)
Practice location
100 Lakeforest Blvd Ste 620Gaithersburg, MD 20877-6203
Phone 301-990-7778
Mailing address
100 Lakeforest Blvd Ste 620Gaithersburg, MD 20877-6203
Phone 301-990-7778
Authorized official
Alireza Rajaei
Owner
3014381200
Is something wrong?
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