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General NPI Number Information
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NPI Number | 1114155694
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Entity Type | Organization
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Legal Business Name | PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 3003 HOSPITAL DR STE 1048
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City | CHEVERLY
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State | MD
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Zip | 20785-1194
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Country | US
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Telephone | 301-583-5900
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Fax | 301-883-7890
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Provider Business Mailing Address
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Address Line | 1701 MCCORMICK DR
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City | LARGO
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State | MD
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Zip | 20774-5329
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Country | US
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Telephone | 301-583-5900
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Fax | 301-883-7890
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MS. TAMALA BUTLER
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Credential |
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Telephone | 301-883-7822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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