MEDICARE: LAUREL LAKES COSMETIC DENTISTRY

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	1223G0001X	General Practice Dentistry	7803	MD

General Provider Information

NPI Number	:	1538204664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL LAKES COSMETIC DENTISTRY

Provider Business Mailing Address
First Line	:	13916 BALTIMORE AVE
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-5009
Country	:	US
Telephone Number	:	301-498-6511
Fax Number	:	301-776-0054

Provider Business Practice Location Address
First Line	:	13916 BALTIMORE AVE
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-5009
Country	:	US
Telephone Number	:	301-498-6511
Fax Number	:	301-776-0054

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL MELNICK
Credential	:	D.D.S.
Telephone Number	:	301-498-6511

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1780846758 — DR. CLAUDIA P. DUMFEH M.D.
Practice Location Address:

13900 BALTIMORE AVE
LAUREL, MD
20707-5009

Practice Phone: 301-725-5652
Practice Fax: 301-483-3723

1831168574 — MR. CYLBURN EARL SODEN SR. M.D.
Practice Location Address:

13920 BALTIMORE AVE
LAUREL, MD
20707-5009

Practice Phone: 301-776-0743
Practice Fax: 301-776-0456

1275609042 — DR. DANIEL MELNICK
Practice Location Address:

13916 BALTIMORE AVE
LAUREL, MD
20707-5009

Practice Phone: 301-498-6511
Practice Fax:

1679621296 — MAURICE SEBASTIAN MILES D.D.S
Practice Location Address:

13916 BALTIMORE AVE
LAUREL, MD
20707-5009

Practice Phone: 301-498-6511
Practice Fax: 301-776-0054

1407905417 — DR. KELLY M BURK
Practice Location Address:

13916 BALTIMORE AVE
LAUREL, MD
20707-5009

Practice Phone: 301-498-6511
Practice Fax: 301-776-0050

1255548988 — PUNEET CHOPRA MD
Practice Location Address:

13900 BALTIMORE AVE
LAUREL, MD
20707-5009

Practice Phone: 301-725-5652
Practice Fax:

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