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General NPI Number Information
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NPI Number | 1346415882
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Entity Type | Organization
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Legal Business Name | MARYLAND ORAL SURGERY ASSOCIATES PA
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1667 CROFTON CTR SUITE 7A
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City | CROFTON
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State | MD
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Zip | 21114-1303
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Country | US
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Telephone | 410-721-0700
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Fax | 410-721-5459
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Provider Business Mailing Address
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Address Line | 14955 SHADY GROVE RD SUITE 330
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City | ROCKVILLE
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State | MD
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Zip | 20850-8700
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Country | US
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Telephone | 301-340-6884
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MAUREEN PETERSEN
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Credential |
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Telephone | 301-340-6884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 12859
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License Number State | MD
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