Provider Demographics
NPI:1942420773
Name:PAYAM HARIRI, D.M.D., P.A.
Entity Type:Organization
Organization Name:PAYAM HARIRI, D.M.D., P.A.
Other - Org Name:CHESAPEAKE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HARTT
Authorized Official - Last Name:COATES
Authorized Official - Suffix:III
Authorized Official - Credentials:BA
Authorized Official - Phone:410-569-9100
Mailing Address - Street 1:2021B EMMORTON RD
Mailing Address - Street 2:STE 222
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8980
Mailing Address - Country:US
Mailing Address - Phone:410-569-9100
Mailing Address - Fax:410-569-9200
Practice Address - Street 1:2021B EMMORTON RD
Practice Address - Street 2:STE 222
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8980
Practice Address - Country:US
Practice Address - Phone:410-569-9100
Practice Address - Fax:410-569-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD114071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty