Healthcare Provider Details

I. General information

NPI: 1174693329
Provider Name (Legal Business Name): ANDREA MCLACHLAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA WOODS-MCLACHLAN DMD

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 YORK RD
TOWSON MD
21204-7446
US

IV. Provider business mailing address

9913 TULIP TREE DR
MITCHELLVILLE MD
20721-3732
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-5004
  • Fax: 410-321-5008
Mailing address:
  • Phone: 267-259-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13602
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401411278
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN1000582
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: