Provider Demographics
NPI:1982778684
Name:ZULFAGHARY, MAHVASH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHVASH
Middle Name:
Last Name:ZULFAGHARY
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 1:11535 FOX RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6279
Mailing Address - Country:US
Mailing Address - Phone:410-740-2395
Mailing Address - Fax:
Practice Address - Street 1:8170 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE#150
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2537
Practice Address - Country:US
Practice Address - Phone:240-456-0717
Practice Address - Fax:240-456-0719
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD228939OtherTRIGON VA
MD256537OtherMAMSI UNITED HEALTHCARE
MD30396OtherAETNA HMO
MD930396OtherAETNA PPO
MD903494OtherUNITED CONCORDIA CO. INC.
MD7458OtherBLUE CROSS BLUE SHIELD