=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386142123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS MINTZ & ABBOTT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2018
-----------------------------------------------------
Last Update Date | 01/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6010 EXECUTIVE BLVD STE 500
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-3827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-530-8570
-----------------------------------------------------
Fax | 301-530-8572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6010 EXECUTIVE BLVD STE 500
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-3827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-530-8570
-----------------------------------------------------
Fax | 301-530-8572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | JEREMY JAMES ABBOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-559-0579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223X2210X
-----------------------------------------------------
Taxonomy Name | Orofacial Pain Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------