Most Relevant Information
Provider Data
| NPI Number: | 1003233156 |
| Provider Name: | MARYAM ROOSTA DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | 15517 |
Most Important Dates
| Enumeration Date: | 03/26/2014 |
| Last Updated: | 11/05/2019 |
Provider Practice Location
9335 BALTIMORE NATIONAL PIKE
ELLICOTT CITY
MD
210422801
Practice Location Phone/Fax
| Phone: | 4104651214 |
| Fax: | 4104652057 |
Provider Mailing Location
5920 GREAT STAR DR UNIT 403
CLARKSVILLE
MD
210291362
Provider Mailing Phone/Fax
| Phone: | 4109006541 |
| Fax: |