Healthcare Provider Details

I. General information

NPI: 1730581554
Provider Name (Legal Business Name): NEGAR HOMAYOUNFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 WEST BALTIMORE STREET UNIVERSITY OF MARYLAND DENTAL SCHOOL
BALTIMORE MD
21201
US

IV. Provider business mailing address

650 WEST BALTIMORE STREET
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-8110
  • Fax:
Mailing address:
  • Phone: 410-706-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number17844
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: