Provider Demographics
NPI:1245885284
Name:SHOEYBI, MANA (DDS)
Entity type:Individual
Prefix:MS
First Name:MANA
Middle Name:
Last Name:SHOEYBI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5661 PHELPS LUCK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2526
Mailing Address - Country:US
Mailing Address - Phone:240-848-0112
Mailing Address - Fax:
Practice Address - Street 1:6955 OAKLAND MILLS RD STE 0
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5849
Practice Address - Country:US
Practice Address - Phone:410-480-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD169431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice