Healthcare Provider Details

I. General information

NPI: 1376353250
Provider Name (Legal Business Name): NAOMI FOTHERGILL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9256 BENDIX RD STE 100
COLUMBIA MD
21045-1843
US

IV. Provider business mailing address

1124 BROENING HWY
BALTIMORE MD
21224-5525
US

V. Phone/Fax

Practice location:
  • Phone: 410-541-1090
  • Fax:
Mailing address:
  • Phone: 773-629-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8455
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: