Organization
SHARON RUSSELL DDS PC
Active
Parent organization
MARYLAND DENTAL SPECIALIST
Other names
The Maryland Oral Surgery Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARYLAND DENTAL SPECIALIST
Authorized official
MARK RUSSELL (COO)
(240) 320-7331
Entity
Organization
Contact information
Practice address
9632 MARLBORO PIKE, MELWOOD PROFESSIONAL CENTER, UPPER MARLBORO, MD 20772-3670
(240) 320-7331
Mailing address
9632 MARLBORO PIKE, MELWOOD PROFESSIONAL CENTER, UPPER MARLBORO, MD 20772-3670
(240) 320-7331
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
14351
MD
1223G0001X
General Practice Dentistry
Primary
14351
MD
1223P0700X
Prosthodontics
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14351
—
MD
Enumeration date
11/04/2013
Last updated
11/04/2013
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