Healthcare Provider Details

I. General information

NPI: 1457960577
Provider Name (Legal Business Name): THURMONT FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E MAIN ST
THURMONT MD
21788-2009
US

IV. Provider business mailing address

105 E MAIN ST
THURMONT MD
21788-2009
US

V. Phone/Fax

Practice location:
  • Phone: 301-271-2346
  • Fax: 301-271-4412
Mailing address:
  • Phone: 301-271-2346
  • Fax: 301-271-4412

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: SARAH M RAYMOND
Title or Position: OWNER
Credential: DDS
Phone: 301-271-2346