Provider Demographics
NPI:1013133370
Name:A.DAVANLOU DDS,PA
Entity Type:Organization
Organization Name:A.DAVANLOU DDS,PA
Other - Org Name:CHARTWELL DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVANLOU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-799-7172
Mailing Address - Street 1:8180 LARK BROWN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6425
Mailing Address - Country:US
Mailing Address - Phone:410-799-7172
Mailing Address - Fax:410-799-7132
Practice Address - Street 1:8180 LARK BROWN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6425
Practice Address - Country:US
Practice Address - Phone:410-799-7172
Practice Address - Fax:410-799-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty