Provider Demographics
NPI:1598966228
Name:MADANI, PARVIN ROYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARVIN
Middle Name:ROYA
Last Name:MADANI
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 1:338 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4301
Mailing Address - Country:US
Mailing Address - Phone:410-234-0020
Mailing Address - Fax:410-685-5405
Practice Address - Street 1:338 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4301
Practice Address - Country:US
Practice Address - Phone:410-234-0020
Practice Address - Fax:410-685-5405
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12335332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522256432OtherTAX ID #