=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689174112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER OUAZANA, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2018
-----------------------------------------------------
Last Update Date | 02/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 SUDBROOK LN
-----------------------------------------------------
City | PIKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-602-8100
-----------------------------------------------------
Fax | 410-602-8135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 SUDBROOK LN
-----------------------------------------------------
City | PIKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-602-8100
-----------------------------------------------------
Fax | 410-602-8135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR.
-----------------------------------------------------
Name | DR. JENNIFER OUAZANA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-602-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------