Provider Demographics
NPI:1528205341
Name:MERAJ DENTAL SPA, PA
Entity Type:Organization
Organization Name:MERAJ DENTAL SPA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-414-2199
Mailing Address - Street 1:1531 MILLERS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:MD
Mailing Address - Zip Code:20676-3113
Mailing Address - Country:US
Mailing Address - Phone:443-624-0356
Mailing Address - Fax:
Practice Address - Street 1:995 NORTH PRINCE FREDERICK BLVD
Practice Address - Street 2:SUITE #108
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-414-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty