MEDICARE: DR. DOUGLAS LA ROI RISK 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	16615	MD
2	1223G0001X	General Practice Dentistry	DEN4845	DC
3	1223G0001X	General Practice Dentistry	16615	MD

General Provider Information

NPI Number	:	1508829458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS LA ROI RISK DDS

Provider Business Mailing Address
First Line	:	3715 CHANCELLORS RUN PL
Second Line	:
City	:	NANJEMOY
State	:	MD
Zip	:	20662-3033
Country	:	US
Telephone Number	:	240-682-1019
Fax Number	:

Provider Business Practice Location Address
First Line	:	13350 HG TRUMAN
Second Line	:
City	:	SOLOMONS
State	:	MD
Zip	:	20688
Country	:	US
Telephone Number	:	410-326-4078
Fax Number	:

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	08/29/2023

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