Healthcare Provider Details

I. General information

NPI: 1598969511
Provider Name (Legal Business Name): ALBERT SAMUEL GRZECH JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AL GRZECH JR. DDS

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7304 E FURNACE BRANCH RD
GLEN BURNIE MD
21060-7056
US

IV. Provider business mailing address

7304 E FURNACE BRANCH RD
GLEN BURNIE MD
21060-7056
US

V. Phone/Fax

Practice location:
  • Phone: 410-424-3552
  • Fax: 410-424-3552
Mailing address:
  • Phone: 410-424-3552
  • Fax: 410-424-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9763
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: