Organization
MD OMS SDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE E VIAL (DIRECT OF CRED AND PROV REL)
(504) 638-0303
Entity
Organization
Contact information
Practice address
5397 TWIN KNOLLS RD STE 18, COLUMBIA, MD 21045-3256
(410) 730-6001
Mailing address
1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
(615) 678-0759
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
11/01/2023
Last updated
11/01/2023
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