Healthcare Provider Details

I. General information

NPI: 1437711983
Provider Name (Legal Business Name): CATONSVILLE ORAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FREDERICK RD STE 9
CATONSVILLE MD
21228-4607
US

IV. Provider business mailing address

405 FREDERICK RD STE 9
CATONSVILLE MD
21228-4607
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-4484
  • Fax: 410-665-3235
Mailing address:
  • Phone: 410-744-4484
  • Fax: 410-665-3235

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: JENNIFER LOEFFLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-744-4484