Healthcare Provider Details

I. General information

NPI: 1275271280
Provider Name (Legal Business Name): STACY EBERLING RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY FURMAN

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 ALEXANDER BELL DR STE 200
COLUMBIA MD
21046-2105
US

IV. Provider business mailing address

100 CROSSING BLVD STE 300
FRAMINGHAM MA
01702-5555
US

V. Phone/Fax

Practice location:
  • Phone: 888-964-6681
  • Fax: 888-662-0859
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4812
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: