# POTOMAC ORAL & MAXILLOFACIAL SURGERY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** POTOMAC ORAL & MAXILLOFACIAL SURGERY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1821858937
- **Legal business name:** POTOMAC ORAL & MAXILLOFACIAL SURGERY
- **Authorized official:** WENDELL GARDNER DDS (OWNER)
- **Authorized official phone:** (410) 257-5333

## Contact information

- **Practice address:** 955 NORTH PRINCE FREDERICK BLVD, SUITE 104, PRINCE FREDERICK, MD 20678-3057
- **Practice address phone:** (410) 535-2416
- **Practice address fax:** (443) 968-8646
- **Mailing address:** 3150 W WARD RD, SUITE 306, DUNKIRK, MD 20754
- **Mailing address phone:** (410) 257-5333
- **Mailing address fax:** (410) 257-2842

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 03/19/2024
- **Last updated:** 03/19/2024