Organization
BOWIE DENTAL GROUP LLC
Active
Other names
Gallant Fox Dental
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY PARK DDS (OWNER/MEMBER)
(301) 464-3500
Entity
Organization
Contact information
Practice address
14300 GALLANT FOX LN STE 208, BOWIE, MD 20715-4033
(301) 464-3500
Mailing address
14300 GALLANT FOX LN STE 208, BOWIE, MD 20715-4033
(301) 464-3500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/23/2019
Last updated
01/23/2019
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