MEDICARE: DR. SCOTT I GRITZ DDS

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	122300000X	Dentist	9929	MD

General Provider Information

NPI Number	:	1386856672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT I GRITZ DDS

Provider Business Mailing Address
First Line	:	11906 DARNESTOWN ROAD
Second Line	:	#A
City	:	N POTOMAC
State	:	MD
Zip	:	20878
Country	:	US
Telephone Number	:	301-926-2700
Fax Number	:	301-926-3214

Provider Business Practice Location Address
First Line	:	11906 DARNESTOWN ROAD
Second Line	:	#A
City	:	N POTOMAC
State	:	MD
Zip	:	20878
Country	:	US
Telephone Number	:	301-926-2700
Fax Number	:	301-926-3214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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