Healthcare Provider Details

I. General information

NPI: 1689247587
Provider Name (Legal Business Name): AKESO CHESAPEAKE ORAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 W JOPPA RD STE 310
LUTHERVILLE TIMONIUM MD
21093-4639
US

IV. Provider business mailing address

6798 OAK HALL LN STE A1
COLUMBIA MD
21045-4892
US

V. Phone/Fax

Practice location:
  • Phone: 410-670-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: TREVANN LYN
Title or Position: OWNER
Credential: DMD
Phone: 443-289-1684