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General NPI Number Information
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NPI Number | 1649597824
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE CONTEMPORARY DENTISTRY, P.A.
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 1308 BUSINESS CENTER WAY SUITE 105
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City | EDGEWOOD
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State | MD
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Zip | 21040-1504
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Country | US
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Telephone | 410-679-2790
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Fax | 410-679-4207
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Provider Business Mailing Address
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Address Line | 1308 BUSINESS CENTER WAY SUITE 105
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City | EDGEWOOD
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State | MD
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Zip | 21040-1504
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Country | US
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Telephone | 410-679-2790
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Fax | 410-679-4207
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Authorized Official
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Title or Position | DOCTOR
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Name | KEITH EDWIN MOOMAW
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Credential | D.D.S.
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Telephone | 410-679-2790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6960
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License Number State | MD
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