Healthcare Provider Details

I. General information

NPI: 1386856672
Provider Name (Legal Business Name): SCOTT I GRITZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11906 DARNESTOWN ROAD #A
N POTOMAC MD
20878
US

IV. Provider business mailing address

11906 DARNESTOWN ROAD #A
N POTOMAC MD
20878
US

V. Phone/Fax

Practice location:
  • Phone: 301-926-2700
  • Fax: 301-926-3214
Mailing address:
  • Phone: 301-926-2700
  • Fax: 301-926-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9929
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: