Provider Demographics
NPI:1801033329
Name:GANJAVIAN, BABAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:GANJAVIAN
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 1:6204 YORKSHIRE TER
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2244
Mailing Address - Country:US
Mailing Address - Phone:301-526-9956
Mailing Address - Fax:
Practice Address - Street 1:100 TUSCANNY DR UNIT C
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-5958
Practice Address - Country:US
Practice Address - Phone:301-695-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist