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General NPI Number Information
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NPI Number | 1477897858
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL WELLNESS CENTER
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Dates
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Enumeration Date | 11/25/2012
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 6020 MEADOWRIDGE CENTER DR
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City | ELKRIDGE
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State | MD
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Zip | 21075-6088
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Country | US
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Telephone | 410-782-3124
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Fax |
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Provider Business Mailing Address
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Address Line | 6020 MEADOWRIDGE CENTER DR
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City | ELKRIDGE
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State | MD
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Zip | 21075-6088
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Country | US
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Telephone | 410-782-3124
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SAMIA AZHAR
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Credential | DDS
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Telephone | 443-857-5317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13217
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License Number State | MD
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