Healthcare Provider Details

I. General information

NPI: 1588821367
Provider Name (Legal Business Name): MARY ELIZABETH PRYOR D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 WESTBARD AVE
BETHESDA MD
20816-4400
US

IV. Provider business mailing address

5325 WESTBARD AVE
BETHESDA MD
20816-4400
US

V. Phone/Fax

Practice location:
  • Phone: 301-915-0997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9170
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: