Organization
MODERN ORAL & FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CYRUS F MISTRY DDS, MD (OWNER)
(301) 610-3918
Entity
Organization
Contact information
Practice address
6191 EXECUTIVE BLVD, ROCKVILLE, MD 20852-3901
(301) 610-3918
(301) 610-3781
Mailing address
6191 EXECUTIVE BLVD, ROCKVILLE, MD 20852-3901
(301) 610-3918
(301) 610-3781
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
07/19/2021
Last updated
07/20/2021
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