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General NPI Number Information
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NPI Number | 1164075917
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Entity Type | Organization
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Legal Business Name | ACADEMY DENTAL CARE LLC
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 37601 GOLDEN BEACH RD.
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City | CHARLOTTE HALL
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State | MD
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Zip | 20622
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Country | US
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Telephone | 301-884-2299
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 828 ACADEMY DENTAL CARE LLC
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City | MECHANICSVILLE
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State | MD
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Zip | 20659
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER OF PRACTICE
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Name | DR. THOMAS RYAN O'SHEA
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Credential | DDS
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Telephone | 301-884-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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