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General NPI Number Information
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NPI Number | 1821574112
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Entity Type | Organization
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Legal Business Name | ADVANCED COSMETIC AND IMPLANT DENTISTRY OF MARYLAND, INC.
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 10085 RED RUN BLVD STE 407
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4896
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Country | US
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Telephone | 410-356-1400
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Fax | 443-288-4288
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Provider Business Mailing Address
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Address Line | 10085 RED RUN BLVD STE 407
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4896
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Country | US
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Telephone | 410-356-1400
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Fax | 443-288-4288
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN C MOORE
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Credential | DMD
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Telephone | 410-356-1400
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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 | 8996
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License Number State | MD
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