Provider Demographics
NPI:1013306893
Name:MRN, INC.
Entity Type:Organization
Organization Name:MRN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMADREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NABAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-221-0161
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3264
Mailing Address - Country:US
Mailing Address - Phone:410-730-8330
Mailing Address - Fax:
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6220
Practice Address - Country:US
Practice Address - Phone:410-730-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty