Provider Demographics
NPI:1487973061
Name:TEBYANIAN, ANIS (DMD MD)
Entity type:Individual
Prefix:DR
First Name:ANIS
Middle Name:
Last Name:TEBYANIAN
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18109 PRINCE PHILIP DR STE 245
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1597
Mailing Address - Country:US
Mailing Address - Phone:301-924-2155
Mailing Address - Fax:310-924-2376
Practice Address - Street 1:18109 PRINCE PHILIP DR STE 245
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1597
Practice Address - Country:US
Practice Address - Phone:301-924-2155
Practice Address - Fax:301-924-2376
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-22
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307611223S0112X
MD162651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty