Individual
MARYAM ROOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
9335 BALTIMORE NATIONAL PIKE, ELLICOTT CITY, MD 21042-2801
(410) 465-1214
(410) 465-2057
Mailing address
5920 GREAT STAR DR UNIT 403, CLARKSVILLE, MD 21029-1362
(410) 900-6541
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15517
MD
Other
Enumeration date
03/26/2014
Last updated
11/05/2019
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