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General NPI Number Information
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NPI Number | 1710436407
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Entity Type | Organization
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Legal Business Name | CENTRAL MARYLAND ORAL AND FACIAL SURGICAL ARTS OF CLARKSVILLE, LLC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 12431 CLARKSVILLE PIKE, ROUTE 108
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City | CLARKSVILLE
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State | MD
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Zip | 21029
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Country | US
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Telephone | 562-293-7339
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Fax |
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Provider Business Mailing Address
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Address Line | 12431 CLARKSVILLE PIKE, ROUTE 108
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City | CLARKSVILLE
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State | MD
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Zip | 21029
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Country | US
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Telephone | 562-293-7339
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | MARY CARTER ROBINSON
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Credential |
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Telephone | 562-293-7339
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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 | 15559
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License Number State | MD
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