Provider Demographics
NPI:1699095372
Name:ANAHITA ABDEHOUDDSPC
Entity type:Organization
Organization Name:ANAHITA ABDEHOUDDSPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDEHOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-812-6001
Mailing Address - Street 1:6830 HOSPITAL DR
Mailing Address - Street 2:SUITE # 106
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4373
Mailing Address - Country:US
Mailing Address - Phone:410-682-3800
Mailing Address - Fax:410-682-5055
Practice Address - Street 1:6830 HOSPITAL DR
Practice Address - Street 2:SUITE # 106
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4373
Practice Address - Country:US
Practice Address - Phone:410-682-3800
Practice Address - Fax:410-682-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty