Provider Demographics
NPI:1154458974
Name:SHROFF, DEVEN V (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:DEVEN
Middle Name:V
Last Name:SHROFF
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 SOUTHERN STAR TER
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-5903
Mailing Address - Country:US
Mailing Address - Phone:410-203-2410
Mailing Address - Fax:410-203-9227
Practice Address - Street 1:10045 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE A-1
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3673
Practice Address - Country:US
Practice Address - Phone:410-203-2410
Practice Address - Fax:410-203-9227
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry