Maryam Roosta, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15517 Issued in MD

Practice address

9335 Baltimore National Pike
Ellicott City, MD 21042-2801

Phone

(410) 465-1214

Fax

(410) 465-2057

NPI assigned

Mar 26, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1003233156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 GREAT STAR DR UNIT 403",
            "city": "CLARKSVILLE",
            "state": "MD",
            "postal_code": "210291362",
            "telephone_number": "410-900-6541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9335 BALTIMORE NATIONAL PIKE",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210422801",
            "telephone_number": "410-465-1214",
            "fax_number": "410-465-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOSTA",
        "first_name": "MARYAM",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-26",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "15517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.