Healthcare Provider Details

I. General information

NPI: 1982759486
Provider Name (Legal Business Name): HOMAYOUN VAZAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 HANOVER PKWY STE B
GREENBELT MD
20770-2016
US

IV. Provider business mailing address

7209 HANOVER PKWY STE B
GREENBELT MD
20770-2016
US

V. Phone/Fax

Practice location:
  • Phone: 301-474-8600
  • Fax: 301-474-8602
Mailing address:
  • Phone: 301-474-8600
  • Fax: 301-474-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11865
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: