Organization
BURWOOD VILLAGE DENTISTRY LLC
Active
Other names
Burwood Village Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
ISHTIAQ ROUF (MANAGER)
(617) 817-0681
Entity
Organization
Contact information
Practice address
1608 W FURNACE BRANCH RD STE A, GLEN BURNIE, MD 21061-1411
(410) 859-1038
Mailing address
1608 W FURNACE BRANCH RD STE A, GLEN BURNIE, MD 21061-1411
(410) 859-1038
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/24/2024
Last updated
01/24/2024
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