Organization
PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Active
Other names
Prince George's County Health Department- Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMALA BUTLER (CREDENTIALING SPECIALIST)
(301) 883-7822
Entity
Organization
Contact information
Practice address
3003 HOSPITAL DR STE 1048, CHEVERLY, MD 20785-1194
(301) 583-5900
(301) 883-7890
Mailing address
1701 MCCORMICK DR, LARGO, MD 20774-5329
(301) 583-5900
(301) 883-7890
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
417155100
—
MD
Enumeration date
06/23/2009
Last updated
09/17/2020
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