Provider Demographics
NPI:1710208715
Name:RADJABLI, EDGAR MAXIMILLIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:MAXIMILLIAN
Last Name:RADJABLI
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 1:3105 EMMORTON RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2582
Mailing Address - Country:US
Mailing Address - Phone:410-569-3555
Mailing Address - Fax:
Practice Address - Street 1:3105 EMMORTON RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2582
Practice Address - Country:US
Practice Address - Phone:410-569-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice