Healthcare Provider Details

I. General information

NPI: 1124143730
Provider Name (Legal Business Name): HARLENE DEBRA SANDLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 SHADY GROVE RD SUITE 420
ROCKVILLE MD
20850-6340
US

IV. Provider business mailing address

15005 SHADY GROVE RD SUITE 420
ROCKVILLE MD
20850-6340
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-0062
  • Fax: 301-762-0056
Mailing address:
  • Phone: 301-762-0062
  • Fax: 301-762-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12067
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: