Provider Demographics
NPI:1477659571
Name:YALDA, BEHNAZ (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:BEHNAZ
Middle Name:
Last Name:YALDA
Suffix:
Gender:F
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-698-5998
Mailing Address - Fax:301-698-5930
Practice Address - Street 1:77 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE D
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-698-5998
Practice Address - Fax:301-698-5930
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics