# AVIE ORAL SURGERY GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013360858
- **Authorized official:** DR. EDNA BUCKLE (PRESIDENT)
- **Authorized official phone:** (678) 982-5136

## Contact information

- **Practice address:** 1215 ANNAPOLIS RD, SUITE 205, ODENTON, MD 21113-1344
- **Practice address phone:** (678) 982-5136
- **Mailing address:** 1215 ANNAPOLIS RD STE 205, ODENTON, MD 21113-1346
- **Mailing address phone:** (678) 982-5136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 14775 | MD | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/17/2016
- **Last updated:** 02/15/2023