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Organization
MARYLAND PERIODONTICS
Active
Organization
MARYLAND PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN MICHELLE LOAR (OFFICE COORDINATOR)
(301) 856-1200
Entity
Organization
Contact information
Practice address
7902 OLD BRANCH AVE, SUITE 209, CLINTON, MD 20735-1646
(301) 856-1200
(301) 868-1947
Mailing address
7902 OLD BRANCH AVE, SUITE 209, CLINTON, MD 20735-1646
(301) 856-1200
(301) 868-1947
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11360
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104066257
NATIONAL PROVIDER ID
—
Enumeration date
11/14/2016
Last updated
11/14/2016
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