Provider Demographics
NPI:1447391503
Name:LOGMANNI, MANDANA GOODARZI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANDANA
Middle Name:GOODARZI
Last Name:LOGMANNI
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 1:5126 DARVEL CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1415
Mailing Address - Country:US
Mailing Address - Phone:410-730-3774
Mailing Address - Fax:
Practice Address - Street 1:8 RUSSELL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2966
Practice Address - Country:US
Practice Address - Phone:301-869-2500
Practice Address - Fax:301-926-7655
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice