Provider Demographics
NPI:1538334172
Name:JANLOO, HAMID REZA (DDS PHD)
Entity type:Individual
Prefix:DR
First Name:HAMID
Middle Name:REZA
Last Name:JANLOO
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 LIBERTY ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784
Mailing Address - Country:US
Mailing Address - Phone:410-795-8878
Mailing Address - Fax:410-795-7794
Practice Address - Street 1:1643 LIBERTY ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784
Practice Address - Country:US
Practice Address - Phone:410-795-8878
Practice Address - Fax:410-795-7794
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist