Healthcare Provider Details

I. General information

NPI: 1568573087
Provider Name (Legal Business Name): ANUSH A JOHN DMD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 YORK RD SUITE A 201
LUTHERVILLE MD
21093
US

IV. Provider business mailing address

1212 YORK RD SUITE A 201
LUTHERVILLE MD
21093-6240
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-7755
  • Fax: 410-337-7922
Mailing address:
  • Phone: 410-337-7755
  • Fax: 410-337-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15530
License Number StateMD

VIII. Authorized Official

Name: LAURIE KOLMER
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-337-7755