MEDICARE: MARYLAND ORAL SURGERY ASSOCIATES PA

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)	12859	MD

General Provider Information

NPI Number	:	1346415882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND ORAL SURGERY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	14955 SHADY GROVE RD
Second Line	:	SUITE 330
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-8700
Country	:	US
Telephone Number	:	301-340-6884
Fax Number	:

Provider Business Practice Location Address
First Line	:	1667 CROFTON CTR
Second Line	:	SUITE 7A
City	:	CROFTON
State	:	MD
Zip	:	21114-1303
Country	:	US
Telephone Number	:	410-721-0700
Fax Number	:	410-721-5459

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MAUREEN PETERSEN
Credential	:
Telephone Number	:	301-340-6884

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	06/25/2008

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