Organization
ORAL AND MAXILLOFACIAL SURGERY SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE GRILLON DMD (PRESIDENT)
(301) 564-1400
Entity
Organization
Contact information
Practice address
10215 FERNWOOD RD, SUITE 510, BETHESDA, MD 20817-1106
(301) 564-1400
(301) 564-1413
Mailing address
10215 FERNWOOD RD, SUITE 510, BETHESDA, MD 20817-1106
(301) 564-1400
(301) 564-1413
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115951800
—
MD
01
—
6374780001
P10
MD
Enumeration date
03/21/2007
Last updated
02/02/2011
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