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General NPI Number Information
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NPI Number | 1922246289
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Entity Type | Individual
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Provider Name | OMID JANLOO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2009
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Last Update Date | 01/25/2009
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Provider Practice Location Address
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Address Line | 7310 ESQUIRE CT SUITE 110
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City | ELKRIDGE
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State | MD
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Zip | 21075-5440
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Country | US
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Telephone | 410-371-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 1643 LIBERTY RD SUITE 102
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City | ELDERSBURG
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State | MD
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Zip | 21784-6544
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Country | US
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Telephone | 410-795-8878
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14100
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License Number State | MD
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