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General NPI Number Information
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NPI Number | 1598262776
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Entity Type | Organization
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Legal Business Name | HOLLEH TAJALLI DDS LLC
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 1030 S LINWOOD AVE UNIT 200
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City | BALTIMORE
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State | MD
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Zip | 21224-5091
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Country | US
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Telephone | 410-707-3704
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Fax |
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Provider Business Mailing Address
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Address Line | 1633 COVINGTON ST
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City | BALTIMORE
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State | MD
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Zip | 21230-4711
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Country | US
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Telephone | 410-707-3704
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Fax |
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Authorized Official
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Title or Position | OWNER AND DENTIST
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Name | DR. HOLLEH TAJALLI
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Credential | DDS
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Telephone | 410-707-3704
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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 | 15974
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License Number State | MD
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