MEDICARE: DENTAL PEARLS P.A.

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	5799	MD

General Provider Information

NPI Number	:	1952321895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL PEARLS P.A.

Provider Business Mailing Address
First Line	:	6339 ALLENTOWN RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-2600
Country	:	US
Telephone Number	:	301-449-2800
Fax Number	:	301-449-2802

Provider Business Practice Location Address
First Line	:	6339 ALLENTOWN RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-2600
Country	:	US
Telephone Number	:	301-449-2800
Fax Number	:	301-449-2802

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. EDWARD ROTH
Credential	:	DDS
Telephone Number	:	301-449-2800

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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