Healthcare Provider Details

I. General information

NPI: 1124518089
Provider Name (Legal Business Name): DENTAL SLEEP SOLUTIONS OF MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 YORK RD STE 204
LUTHERVILLE MD
21093-6042
US

IV. Provider business mailing address

1407 YORK RD STE 204
LUTHERVILLE MD
21093-6042
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-5079
  • Fax: 410-321-1610
Mailing address:
  • Phone: 410-821-5079
  • Fax: 410-321-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5916
License Number StateMD

VIII. Authorized Official

Name: DR. MARTIN T LANG
Title or Position: OWNER
Credential: DDS
Phone: 410-821-5079