MEDICARE: DAVIDSONVILLE DENTAL GROUP LLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1568260024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIDSONVILLE DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	3102 DAVIDSONVILLE RD
Second Line	:
City	:	DAVIDSONVILLE
State	:	MD
Zip	:	21035-1803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3102 DAVIDSONVILLE RD
Second Line	:
City	:	DAVIDSONVILLE
State	:	MD
Zip	:	21035-1803
Country	:	US
Telephone Number	:	410-956-5555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARC EUN
Credential	:	DMD
Telephone Number	:	703-732-3996

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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