Provider Demographics
NPI:1477897858
Name:FAMILY DENTAL WELLNESS CENTER
Entity Type:Organization
Organization Name:FAMILY DENTAL WELLNESS CENTER
Other - Org Name:SAMIA AZHAR
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-857-5317
Mailing Address - Street 1:6020 MEADOWRIDGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6088
Mailing Address - Country:US
Mailing Address - Phone:410-782-3124
Mailing Address - Fax:
Practice Address - Street 1:6020 MEADOWRIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6088
Practice Address - Country:US
Practice Address - Phone:410-782-3124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-25
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132171223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty