Provider Demographics
NPI:1538189824
Name:JAVANMARDIAN, MARJAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARJAN
Middle Name:
Last Name:JAVANMARDIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 BIELENBERG DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1705
Mailing Address - Country:US
Mailing Address - Phone:651-200-4747
Mailing Address - Fax:651-998-1009
Practice Address - Street 1:683 BIELENBERG DR
Practice Address - Street 2:SUITE 205
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1705
Practice Address - Country:US
Practice Address - Phone:651-200-4747
Practice Address - Fax:651-998-1009
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN251840OtherCIGNA
MN45102OtherUHC
MN516659OtherAETNA