Provider Demographics
NPI:1063802866
Name:HOMAYOUN VAZAN DDS.LLC
Entity type:Organization
Organization Name:HOMAYOUN VAZAN DDS.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-446-0100
Mailing Address - Street 1:7209 HANOVER PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2016
Mailing Address - Country:US
Mailing Address - Phone:301-446-0100
Mailing Address - Fax:
Practice Address - Street 1:7209 HANOVER PKWY STE B
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2016
Practice Address - Country:US
Practice Address - Phone:301-446-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11865261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental