MEDICARE: SOUTHERN MARYLAND ORAL & MAXILLOFACIAL SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	5594	MD

General Provider Information

NPI Number	:	1174559298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN MARYLAND ORAL & MAXILLOFACIAL SURGERY

Provider Business Mailing Address
First Line	:	3450 OLD WASHINGTON RD
Second Line	:	SUITE 201
City	:	WALDORF
State	:	MD
Zip	:	20602-3248
Country	:	US
Telephone Number	:	301-645-6911
Fax Number	:	301-843-0083

Provider Business Practice Location Address
First Line	:	3450 OLD WASHINGTON RD
Second Line	:	SUITE 201
City	:	WALDORF
State	:	MD
Zip	:	20602-3248
Country	:	US
Telephone Number	:	301-645-6911
Fax Number	:	301-843-0083

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN J HEFFRON
Credential	:	D.D.S.
Telephone Number	:	301-807-3230

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1205818325 — DR. LANE T KNIGHT DDS
Practice Location Address:

3450 OLD WASHINGTON RD , STE 201
WALDORF, MD
20602-3248

Practice Phone: 301-645-6911
Practice Fax: 301-843-0083

1659353423 — DR. JOHN J HEFFRON DDS
Practice Location Address:

3450 OLD WASHINGTON RD , SUITE 201
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1811970056 — RICHARD EUGENE COOK JR. M.D.
Practice Location Address:

3450 OLD WASHINGTON RD , SUITE 103
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Practice Phone: 301-472-4290
Practice Fax: 240-607-3609

1427123983 — MR. DAVID EDWARD KANE D.C.
Practice Location Address:

3450 OLD WASHINGTON RD , SUITE 101
WALDORF, MD
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1417143041 — ADVANCED SURGICARE OF MARYLAND P.A
Practice Location Address:

3450 OLD WASHINGTON RD , SUITE 202
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1932377702 — MS. JOYCE JACQUETTA JACKSON NP
Practice Location Address:

3450 OLD WASHINGTON ROAD , SUITE 202
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20602-3248

Practice Phone: 301-645-3590
Practice Fax: 301-705-1941

Directions to “SOUTHERN MARYLAND ORAL & MAXILLOFACIAL SURGERY ” Practice Location

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