MEDICARE: DENTAL ASSOCIATES OF GREATER MARYLAND

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	261QD0000X	Dental Clinic/Center	13144	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710227863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL ASSOCIATES OF GREATER MARYLAND

Provider Business Mailing Address
First Line	:	6339 ALLENTOWN RD STE E
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-2600
Country	:	US
Telephone Number	:	301-449-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 ALLENTOWN RD STE E
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-2600
Country	:	US
Telephone Number	:	301-449-2800
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. STANLEY J. PARK
Credential	:
Telephone Number	:	410-997-8383

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	02/27/2013

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