Healthcare Provider Details

I. General information

NPI: 1598687741
Provider Name (Legal Business Name): HAGERSTOWN PRIME DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 HOWELL RD STE 1
HAGERSTOWN MD
21740-6619
US

IV. Provider business mailing address

1825 HOWELL RD STE 1
HAGERSTOWN MD
21740-6619
US

V. Phone/Fax

Practice location:
  • Phone: 301-766-7000
  • Fax: 301-323-8639
Mailing address:
  • Phone: 301-766-7000
  • Fax: 301-323-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HEUNG JOO SUNG
Title or Position: CEO
Credential:
Phone: 301-766-7000