Healthcare Provider Details

I. General information

NPI: 1629175765
Provider Name (Legal Business Name): ROBERT B TESTANI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FREDERICK ROAD SUITE #9
CATONSVILLE MD
21228
US

IV. Provider business mailing address

11636 QUARTERFIELD DRIVE
ELLICOTT CITY MD
21042
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-4484
  • Fax: 410-455-9299
Mailing address:
  • Phone: 443-535-9091
  • Fax: 410-455-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number07714
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: