Healthcare Provider Details

I. General information

NPI: 1730300609
Provider Name (Legal Business Name): ALVIN S. RO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 THOMAS JOHNSON DR SUITE 11
FREDERICK MD
21702-4398
US

IV. Provider business mailing address

19341 CYPRESS HILL WAY
GAITHERSBURG MD
20879-4983
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-8181
  • Fax: 301-682-8183
Mailing address:
  • Phone: 301-869-8894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12602
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: