Individual
MOSES PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
780 GOVERNOR RITCHIE HWY STE 30, SEVERNA PARK, MD 21146-4135
(410) 384-9030
Mailing address
13100 DAIRYMAID DR, GERMANTOWN, MD 20874-2311
(423) 715-8593
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18005
MD
Other
Enumeration date
06/01/2023
Last updated
06/01/2023
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