Provider Demographics
NPI:1285800383
Name:JOHN, ANUSH (MD, DMIN, DMD)
Entity type:Individual
Prefix:DR
First Name:ANUSH
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD, DMIN, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 YORK RD STE 304
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2260
Mailing Address - Country:US
Mailing Address - Phone:410-337-7755
Mailing Address - Fax:
Practice Address - Street 1:2405 YORK RD STE 304
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2260
Practice Address - Country:US
Practice Address - Phone:410-337-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080072271223S0112X
MD155301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery