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General NPI Number Information
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NPI Number | 1013306893
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Entity Type | Organization
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Legal Business Name | MRN, INC.
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 10630 LITTLE PATUXENT PKWY STE 100
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City | COLUMBIA
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State | MD
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Zip | 21044-6220
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Country | US
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Telephone | 410-730-8330
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Fax |
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Provider Business Mailing Address
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Address Line | 10630 LITTLE PATUXENT PKWY
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City | COLUMBIA
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State | MD
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Zip | 21044-3264
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Country | US
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Telephone | 410-730-8330
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. MOHAMMADREZA NABAVI
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Credential | DDS
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Telephone | 301-221-0161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14871
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License Number State | MD
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