Healthcare Provider Details

I. General information

NPI: 1780199166
Provider Name (Legal Business Name): KIAN DJAWDAN DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HARRY S TRUMAN PKWY
ANNAPOLIS MD
21401-7601
US

IV. Provider business mailing address

200 HARRY S TRUMAN PKWY STE 200
ANNAPOLIS MD
21401-7348
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-7645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIAN DJAWDAN
Title or Position: OWNER
Credential:
Phone: 410-266-7645