Provider Demographics
NPI:1629175765
Name:TESTANI, ROBERT B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:TESTANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11636 QUARTERFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:443-535-9091
Mailing Address - Fax:410-455-9299
Practice Address - Street 1:405 FREDERICK ROAD
Practice Address - Street 2:SUITE #9
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-744-4484
Practice Address - Fax:410-455-9299
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD077141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T59451Medicare UPIN
R069Medicare ID - Type Unspecified