Healthcare Provider Details

I. General information

NPI: 1023957958
Provider Name (Legal Business Name): SOHAIL MAIWAND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12145 ELM ST
PRINCESS ANNE MD
21853-1358
US

IV. Provider business mailing address

12165 ELM ST
PRINCESS ANNE MD
21853-1358
US

V. Phone/Fax

Practice location:
  • Phone: 410-651-1000
  • Fax:
Mailing address:
  • Phone: 410-651-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberLL945
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: