Healthcare Provider Details

I. General information

NPI: 1902164635
Provider Name (Legal Business Name): LUKE SAMUEL DOHMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 PRINCE FREDERICK BLVD STE 108
PRINCE FREDERICK MD
20678-3199
US

IV. Provider business mailing address

995 PRINCE FREDERICK BLVD STE 108
PRINCE FREDERICK MD
20678-3199
US

V. Phone/Fax

Practice location:
  • Phone: 443-968-8575
  • Fax: 443-432-0082
Mailing address:
  • Phone: 443-968-8575
  • Fax: 443-432-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number164635
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: