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General NPI Number Information
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NPI Number | 1700270527
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Entity Type | Organization
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Legal Business Name | GOLDEN DRAGONFLY ACUPUNCTURE & ORIENTAL MEDICINE
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 221 MARKET ST
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City | DENTON
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State | MD
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Zip | 21629-1036
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Country | US
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Telephone | 443-448-4833
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Fax | 443-448-4834
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Provider Business Mailing Address
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Address Line | 221 MARKET ST
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City | DENTON
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State | MD
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Zip | 21629-1036
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Country | US
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Telephone | 443-448-4833
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Fax | 443-448-4834
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Authorized Official
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Title or Position | MANAGER
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Name | MR. GUY GRANVILLE WELLS
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Credential |
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Telephone | 443-448-4833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U02099
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License Number State | MD
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