Healthcare Provider Details

I. General information

NPI: 1467677393
Provider Name (Legal Business Name): DELBAND VAZIRNEZAMI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13940 BALTIMORE AVE
LAUREL MD
20707-5000
US

IV. Provider business mailing address

13940 BALTIMORE AVE
LAUREL MD
20707-5000
US

V. Phone/Fax

Practice location:
  • Phone: 301-369-0000
  • Fax:
Mailing address:
  • Phone: 301-369-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11680
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: