Healthcare Provider Details

I. General information

NPI: 1386142123
Provider Name (Legal Business Name): DRS MINTZ & ABBOTT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 EXECUTIVE BLVD STE 500
ROCKVILLE MD
20852-3827
US

IV. Provider business mailing address

6010 EXECUTIVE BLVD STE 500
ROCKVILLE MD
20852-3827
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-8570
  • Fax: 301-530-8572
Mailing address:
  • Phone: 301-530-8570
  • Fax: 301-530-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEREMY JAMES ABBOTT
Title or Position: DENTIST/OWNER
Credential:
Phone: 805-559-0579