Healthcare Provider Details

I. General information

NPI: 1417755455
Provider Name (Legal Business Name): BRIANNA THEWSUVAT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PLUMTREE RD STE E
BEL AIR MD
21015-6056
US

IV. Provider business mailing address

349 TIMBER GROVE RD
OWINGS MILLS MD
21117-1320
US

V. Phone/Fax

Practice location:
  • Phone: 410-304-3331
  • Fax:
Mailing address:
  • Phone: 410-409-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18997
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: