Healthcare Provider Details

I. General information

NPI: 1316718042
Provider Name (Legal Business Name): KEROLOS MICHAEL DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12520 PROSPERITY DR STE 340
SILVER SPRING MD
20904-1606
US

IV. Provider business mailing address

12520 PROSPERITY DR STE 340
SILVER SPRING MD
20904-1606
US

V. Phone/Fax

Practice location:
  • Phone: 301-388-2420
  • Fax:
Mailing address:
  • Phone: 301-388-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEROLOS MICHAEL
Title or Position: OWNER
Credential: DDS
Phone: 440-521-1215