Healthcare Provider Details

I. General information

NPI: 1245742741
Provider Name (Legal Business Name): AKESO ORAFACIAL MAXILLARY SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7544 BELAIR ROAD
NOTTINGHAM MD
21236
US

IV. Provider business mailing address

7544 BELAIR RD
NOTTINGHAM MD
21236-4108
US

V. Phone/Fax

Practice location:
  • Phone: 410-665-2500
  • Fax: 410-665-3235
Mailing address:
  • Phone: 410-665-2500
  • Fax: 410-665-3235

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: DR. TREVANN LYN
Title or Position: OWNER/ORAL SURGEON
Credential: DMD
Phone: 410-665-2500