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General NPI Number Information
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NPI Number | 1295889822
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Entity Type | Organization
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Legal Business Name | BERGER & WADDELL LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20 RIDGELY AVE SUITE 306
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1410
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Country | US
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Telephone | 410-268-9336
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Fax | 410-268-9428
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Provider Business Mailing Address
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Address Line | 20 RIDGELY AVE SUITE 306
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1410
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Country | US
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Telephone | 410-268-9336
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Fax | 410-268-9428
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JODY M WADDELL
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Credential | DDS
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Telephone | 410-268-9336
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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 | 10179
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License Number State | MD
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