Healthcare Provider Details

I. General information

NPI: 1760633663
Provider Name (Legal Business Name): CORNERSTONE ORAL & MAXILLOFACIAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BALTIMORE BLVD UNIT C-1
WESTMINSTER MD
21157-7098
US

IV. Provider business mailing address

1130 BALTIMORE BLVD UNIT C-1
WESTMINSTER MD
21157-7098
US

V. Phone/Fax

Practice location:
  • Phone: 410-982-0650
  • Fax: 410-982-0655
Mailing address:
  • Phone: 410-982-0650
  • Fax: 410-982-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number13760
License Number StateMD

VIII. Authorized Official

Name: DR. JENNIFER N FORSHEY
Title or Position: OWNER/SURGEON
Credential: DMD, MD
Phone: 240-529-8863