Provider Demographics
NPI:1386179646
Name:JAVADKHANI, ELNAZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELNAZ
Middle Name:
Last Name:JAVADKHANI
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 1:7425 BALTIMORE ANNAPOLIS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3501
Mailing Address - Country:US
Mailing Address - Phone:410-760-5120
Mailing Address - Fax:
Practice Address - Street 1:7425 BALTIMORE ANNAPOLIS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3501
Practice Address - Country:US
Practice Address - Phone:410-760-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402204090124Q00000X
VA0401415762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist