Healthcare Provider Details

I. General information

NPI: 1659548881
Provider Name (Legal Business Name): EDWIN ZAGHI DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 LITTLE PATUXENT PKWY STE 103R
COLUMBIA MD
21044-3081
US

IV. Provider business mailing address

10910 LITTLE PATUXENT PKWY STE 103R
COLUMBIA MD
21044-3081
US

V. Phone/Fax

Practice location:
  • Phone: 917-846-7655
  • Fax:
Mailing address:
  • Phone: 917-846-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13444
License Number StateMD

VIII. Authorized Official

Name: DR. EDWIN ZAGHI
Title or Position: OWNER
Credential: DMD
Phone: 410-992-4400