Healthcare Provider Details

I. General information

NPI: 1982652053
Provider Name (Legal Business Name): PAYAM HARIRI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 FRANKLIN AVE STE 303
BERLIN MD
21811-1238
US

IV. Provider business mailing address

314 FRANKLIN AVE STE 303
BERLIN MD
21811-1238
US

V. Phone/Fax

Practice location:
  • Phone: 410-629-1240
  • Fax: 410-569-9200
Mailing address:
  • Phone: 410-629-1240
  • Fax: 410-569-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberMD11407
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: