Healthcare Provider Details

I. General information

NPI: 1932309432
Provider Name (Legal Business Name): EDWIN ZAGHI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
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:
Title or Position:
Credential:
Phone: