MEDICARE: BURTONSVILLE DENTAL SUITE, LLC

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

General Provider Information

NPI Number	:	1457007155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURTONSVILLE DENTAL SUITE, LLC

Provider Business Mailing Address
First Line	:	3905 NATIONAL DR STE 370
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-6117
Country	:	US
Telephone Number	:	301-421-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 NATIONAL DR STE 340
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-6111
Country	:	US
Telephone Number	:	301-421-1300
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. HEATHER GRUNDY
Credential	:
Telephone Number	:	301-421-1300

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	05/26/2026

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