Healthcare Provider Details

I. General information

NPI: 1831862580
Provider Name (Legal Business Name): REZA TAFRISHI D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 N POINT BLVD STE 601
BALTIMORE MD
21224-3362
US

IV. Provider business mailing address

11666 FARSIDE RD
ELLICOTT CITY MD
21042-1532
US

V. Phone/Fax

Practice location:
  • Phone: 240-505-0429
  • Fax:
Mailing address:
  • Phone: 240-505-0429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: REZA TAFRISHI
Title or Position: PRESIDENT
Credential: DDS
Phone: 410-284-6650