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General NPI Number Information
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NPI Number | 1821693300
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Entity Type | Organization
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Legal Business Name | EVOLUTION ORAL SURGERY
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 19851 OBSERVATION DR STE 320
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City | GERMANTOWN
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State | MD
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Zip | 20876-4143
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Country | US
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Telephone | 301-916-6000
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Fax | 301-916-6113
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Provider Business Mailing Address
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Address Line | 19851 OBSERVATION DR STE 320
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City | GERMANTOWN
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State | MD
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Zip | 20876-4143
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Country | US
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Telephone | 301-916-6000
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Fax | 301-916-6113
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Authorized Official
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Title or Position | ORAL SURGEON/OWNER
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Name | JAMES RYAN
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Credential | DDS
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Telephone | 301-916-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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