Provider Demographics
NPI:1609487891
Name:ANIS TEBYANIAN DMD MD PA
Entity Type:Organization
Organization Name:ANIS TEBYANIAN DMD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TEBYANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MD
Authorized Official - Phone:301-924-2155
Mailing Address - Street 1:18109 PRINCE PHILIP DR STE 245
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1597
Mailing Address - Country:US
Mailing Address - Phone:301-924-2155
Mailing Address - Fax:301-924-2376
Practice Address - Street 1:18109 PRINCE PHILIP DR STE 245
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1597
Practice Address - Country:US
Practice Address - Phone:301-924-2155
Practice Address - Fax:301-924-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty