Healthcare Provider Details

I. General information

NPI: 1508915802
Provider Name (Legal Business Name): CHESAPEAKE ENDODONTICS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 BESTGATE RD SUITE 213
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

888 BESTGATE RD #213
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-7556
  • Fax: 410-224-4206
Mailing address:
  • Phone: 410-224-7556
  • Fax: 410-224-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFERY OLIVER LUZADER
Title or Position: MEMBER
Credential: ENDODONTIST DDS
Phone: 410-224-7556