Healthcare Provider Details

I. General information

NPI: 1275207474
Provider Name (Legal Business Name): UMAR SHAHBAZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9110 PHILADELPHIA RD STE 214
ROSEDALE MD
21237-4325
US

IV. Provider business mailing address

6016 DUVALLS FOREST DR
FREDERICK MD
21701-3588
US

V. Phone/Fax

Practice location:
  • Phone: 410-780-0120
  • Fax: 443-495-6070
Mailing address:
  • Phone: 443-736-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17549
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: