Healthcare Provider Details

I. General information

NPI: 1487732491
Provider Name (Legal Business Name): AARON JAMES VAFAKOS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E BROADWAY
BEL AIR MD
21014-2904
US

IV. Provider business mailing address

136 E BROADWAY
BEL AIR MD
21014-2904
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-8706
  • Fax: 410-893-3691
Mailing address:
  • Phone: 410-893-8706
  • Fax: 410-893-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12484
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: