Provider Demographics
NPI:1255468799
Name:KAVANDI, SHOREH S (DDS)
Entity Type:Individual
Prefix:
First Name:SHOREH
Middle Name:S
Last Name:KAVANDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8363 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4831
Mailing Address - Country:US
Mailing Address - Phone:301-953-3021
Mailing Address - Fax:
Practice Address - Street 1:8363 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4831
Practice Address - Country:US
Practice Address - Phone:301-953-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD11634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist