Healthcare Provider Details

I. General information

NPI: 1164130027
Provider Name (Legal Business Name): MARYLAND HOLISTIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 GENERALS HWY
CROWNSVILLE MD
21032-1421
US

IV. Provider business mailing address

1017 GENERALS HWY
CROWNSVILLE MD
21032-1421
US

V. Phone/Fax

Practice location:
  • Phone: 410-923-2586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GENA FRIES SCHULTHEIS
Title or Position: OWNER
Credential: DDS
Phone: 410-905-8738