| Organization Name: | HOMAYOUN VAZAN DDS.LLC |
| NPI Number: | 1063802866 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HOMAYOUN VAZAN (PRESIDENT) |
| Mailing Address: | 7209 Hanover Pkwy Ste B Greenbelt |
| State: | MD US |
| Postal Code: | 207702016 |
| Phone Number: | 3014460100 |
| Fax Number: | |
| NPI Enumeration Date: | 01/31/2015 |
| NPI Last Update Date: | 01/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 11865 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |