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General NPI Number Information
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NPI Number | 1740722339
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Entity Type | Organization
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Legal Business Name | MARYLAND PERIODONTICS
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 7902 OLD BRANCH AVE SUITE 209
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City | CLINTON
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State | MD
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Zip | 20735-1646
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Country | US
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Telephone | 301-856-1200
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Fax | 301-868-1947
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Provider Business Mailing Address
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Address Line | 7902 OLD BRANCH AVE SUITE 209
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City | CLINTON
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State | MD
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Zip | 20735-1646
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Country | US
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Telephone | 301-856-1200
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Fax | 301-868-1947
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | KAREN MICHELLE LOAR
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Credential |
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Telephone | 301-856-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 11360
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License Number State | MD
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