Healthcare Provider Details

I. General information

NPI: 1861299539
Provider Name (Legal Business Name): MILORD ROSEBOROUGH RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 RIVERVIEW CT APT 304
LAUREL MD
20707-4135
US

IV. Provider business mailing address

13 RIVERVIEW CT APT 304
LAUREL MD
20707-4135
US

V. Phone/Fax

Practice location:
  • Phone: 301-356-4425
  • Fax:
Mailing address:
  • Phone: 301-356-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7668
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: