MEDICARE: THE ORAL SURGERY CENTER AT MITCHELLVILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	13106	MD

General Provider Information

NPI Number	:	1013345511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ORAL SURGERY CENTER AT MITCHELLVILLE

Provider Business Mailing Address
First Line	:	12164 CENTRAL AVE STE 224
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-1903
Country	:	US
Telephone Number	:	301-627-1105
Fax Number	:	301-627-1105

Provider Business Practice Location Address
First Line	:	12164 CENTRAL AVE STE 224
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-1903
Country	:	US
Telephone Number	:	301-627-1105
Fax Number	:	301-627-1105

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MIARI-ANN GRIFFITH
Credential	:	DDS
Telephone Number	:	301-627-1105

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	10/17/2013

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Directions to “THE ORAL SURGERY CENTER AT MITCHELLVILLE ” Practice Location

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