Provider Demographics
NPI:1750893095
Name:EZ SMILE DENTAL INC
Entity type:Organization
Organization Name:EZ SMILE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-488-0600
Mailing Address - Street 1:5006 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5936
Mailing Address - Country:US
Mailing Address - Phone:410-488-0600
Mailing Address - Fax:
Practice Address - Street 1:5006 SINCLAIR LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5936
Practice Address - Country:US
Practice Address - Phone:410-488-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14008261QD0000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty