Provider Demographics
NPI:1669558854
Name:GAZNAVI, POURANG (DDS)
Entity type:Individual
Prefix:DR
First Name:POURANG
Middle Name:
Last Name:GAZNAVI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:GAZNAVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5542 NORBECK ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853
Mailing Address - Country:US
Mailing Address - Phone:301-460-5000
Mailing Address - Fax:301-460-5882
Practice Address - Street 1:5542 NORBECK ROAD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853
Practice Address - Country:US
Practice Address - Phone:301-460-5000
Practice Address - Fax:301-460-5882
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice