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General NPI Number Information
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NPI Number | 1528205341
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Entity Type | Organization
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Legal Business Name | MERAJ DENTAL SPA, PA
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 995 NORTH PRINCE FREDERICK BLVD SUITE #108
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678
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Country | US
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Telephone | 410-414-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 1531 MILLERS WAY
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City | PORT REPUBLIC
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State | MD
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Zip | 20676-3113
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Country | US
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Telephone | 443-624-0356
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHARMIN MERAJ
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Credential | DDS
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Telephone | 410-414-2199
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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 | 13185
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License Number State | MD
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