Healthcare Provider Details

I. General information

NPI: 1447377718
Provider Name (Legal Business Name): ALAN J. GOODFRIEND, DMD, GLENN C. SCHERMER, DMD, GUIDO COSTA, DMD,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 MALCOLM RD SUITE 300
CLINTON MD
20735-1734
US

IV. Provider business mailing address

7905 MALCOLM RD SUITE 300
CLINTON MD
20735-1734
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-5500
  • Fax: 301-877-9393
Mailing address:
  • Phone: 301-868-5500
  • Fax: 301-877-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5056
License Number StateMD

VIII. Authorized Official

Name: MRS. JANET DAVISON
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-868-5500