Healthcare Provider Details

I. General information

NPI: 1659413326
Provider Name (Legal Business Name): MICHAEL S SAOUD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CENTENNIAL STREET, STE 1A
LA PLATA MD
20646-2503
US

IV. Provider business mailing address

PO BOX 2503 201 CENTENNIAL STREET, STE 1A
LA PLATA MD
20646-2503
US

V. Phone/Fax

Practice location:
  • Phone: 301-934-3500
  • Fax: 301-934-2277
Mailing address:
  • Phone: 301-934-3500
  • Fax: 301-934-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11740
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: