Healthcare Provider Details

I. General information

NPI: 1508957051
Provider Name (Legal Business Name): JOAN J EMBERLAND DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28095 THREE NOTCH RD STE 1A
MECHANICSVILLE MD
20659-3373
US

IV. Provider business mailing address

28095 THREE NOTCH RD STE 1A
MECHANICSVILLE MD
20659-3373
US

V. Phone/Fax

Practice location:
  • Phone: 301-884-8133
  • Fax: 301-884-0513
Mailing address:
  • Phone: 301-884-8133
  • Fax: 301-884-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9616
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: