Provider Demographics
NPI:1760823892
Name:AFGAN, NADER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:AFGAN
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 1:100 CRAIN HWY S
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3528
Mailing Address - Country:US
Mailing Address - Phone:410-969-9300
Mailing Address - Fax:410-969-9311
Practice Address - Street 1:100 CRAIN HWY S
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3528
Practice Address - Country:US
Practice Address - Phone:410-969-9300
Practice Address - Fax:410-969-9311
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD111047100Medicaid