Healthcare Provider Details

I. General information

NPI: 1013306893
Provider Name (Legal Business Name): MRN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY STE 100
COLUMBIA MD
21044-6220
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-3264
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-8330
  • Fax:
Mailing address:
  • Phone: 410-730-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14871
License Number StateMD

VIII. Authorized Official

Name: DR. MOHAMMADREZA NABAVI
Title or Position: DOCTOR/OWNER
Credential: DDS
Phone: 301-221-0161