Healthcare Provider Details

I. General information

NPI: 1255837167
Provider Name (Legal Business Name): IVAN LIANG ZHANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11933 GEORGIA AVE
SILVER SPRING MD
20902-2001
US

IV. Provider business mailing address

11933 GEORGIA AVE
SILVER SPRING MD
20902-2001
US

V. Phone/Fax

Practice location:
  • Phone: 301-200-8015
  • Fax:
Mailing address:
  • Phone: 240-833-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019032035
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number16858
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: