Healthcare Provider Details

I. General information

NPI: 1164548335
Provider Name (Legal Business Name): ORAL AND MAXILLOFACIAL SURGERY SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD SUITE 510
BETHESDA MD
20817-1106
US

IV. Provider business mailing address

10215 FERNWOOD RD SUITE 510
BETHESDA MD
20817-1106
US

V. Phone/Fax

Practice location:
  • Phone: 301-564-1400
  • Fax: 301-564-1413
Mailing address:
  • Phone: 301-564-1400
  • Fax: 301-564-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE GRILLON
Title or Position: PRESIDENT
Credential: DMD
Phone: 301-564-1400