Healthcare Provider Details

I. General information

NPI: 1780960120
Provider Name (Legal Business Name): THREE LOWER COUNTIES COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32033 BEAVER RUN DR
SALISBURY MD
21804-1773
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-1015
  • Fax: 410-749-1020
Mailing address:
  • Phone: 410-749-1015
  • Fax: 410-749-1020

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 Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN E HOLLAND
Title or Position: PRESIDENT/CEO
Credential:
Phone: 410-749-1015