Healthcare Provider Details

I. General information

NPI: 1659812345
Provider Name (Legal Business Name): ROBERT MICHAEL MCCREADY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/25/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 SNOW HILL RD
SALISBURY MD
21804-1938
US

IV. Provider business mailing address

835 SNOW HILL RD
SALISBURY MD
21804-1938
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-7770
  • Fax: 410-546-7749
Mailing address:
  • Phone: 410-546-7770
  • Fax: 410-546-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16419
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: