Active NPI
Azita Davanlou, DDS
- Dentist
- Elkridge, MD
National Provider Identifier
1093726846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12454
- Practice address
- 8180 Lark Brown Road
Suite #202
Elkridge, MD 21075 - Phone
- (410) 799-7172
- Fax
- (410) 799-7132
- NPI assigned
- Aug 10, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12454 | MD | Primary |
Addresses
Primary practice location
8180 Lark Brown Road
Suite #202
Elkridge, MD 21075
Mailing address
2810 Pfefferkorn Road
West Friendship, MD 21794
Phone (410) 489-9860
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12454 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A.Davanlou DDS,PA | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093726846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2810 PFEFFERKORN ROAD",
"city": "WEST FRIENDSHIP",
"state": "MD",
"postal_code": "21794",
"telephone_number": "410-489-9860",
"fax_number": "410-489-9861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8180 LARK BROWN ROAD",
"address_2": "SUITE #202",
"city": "ELKRIDGE",
"state": "MD",
"postal_code": "21075",
"telephone_number": "410-799-7172",
"fax_number": "410-799-7132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVANLOU",
"first_name": "AZITA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "12454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elkridge, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.