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General NPI Number Information
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NPI Number | 1518405117
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Entity Type | Organization
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Legal Business Name | ADVANCE DENTAL CLINIC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 700 GEIPE RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-4147
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Country | US
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Telephone | 443-251-5580
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Fax |
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Provider Business Mailing Address
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Address Line | 700 GEIPE RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-4147
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Country | US
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Telephone | 443-251-5580
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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. MARYAM BEMANI
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Credential |
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Telephone | 443-251-5580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15152
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License Number State | MD
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