Healthcare Provider Details

I. General information

NPI: 1245910975
Provider Name (Legal Business Name): CALVERT DENTISTRY MOY P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 MERRIMAC CT
PRINCE FREDERICK MD
20678-4133
US

IV. Provider business mailing address

13942 BROMFIELD RD
GERMANTOWN MD
20874-2293
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-2011
  • Fax:
Mailing address:
  • Phone: 301-250-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER GRUNDY
Title or Position: OFFICE MANAGER
Credential:
Phone: 443-926-2719