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Organization
AVIE ORAL SURGERY GROUP
Active
Organization
AVIE ORAL SURGERY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDNA BUCKLE (PRESIDENT)
(678) 982-5136
Entity
Organization
Contact information
Practice address
1215 ANNAPOLIS RD, SUITE 205, ODENTON, MD 21113-1344
(678) 982-5136
Mailing address
1215 ANNAPOLIS RD STE 205, ODENTON, MD 21113-1346
(678) 982-5136
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
14775
MD
261QD0000X
Dental Clinic/Center
—
NULL
Other
Enumeration date
07/17/2016
Last updated
02/15/2023
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