Healthcare Provider Details

I. General information

NPI: 1497716096
Provider Name (Legal Business Name): M. REZA GHAJARNIA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9433 ANNAPOLIS RD
LANHAM MD
20706-3020
US

IV. Provider business mailing address

9433 ANNAPOLIS RD
LANHAM MD
20706-3020
US

V. Phone/Fax

Practice location:
  • Phone: 412-953-8928
  • Fax:
Mailing address:
  • Phone: 412-953-8928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14378
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS035239
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS035239
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: