Organization
AKESO OROFACIAL SURGERY, LLC
Active
Other names
Laurel Oral Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TREVANN LYN DMD (OWNER)
(301) 329-5758
Entity
Organization
Contact information
Practice address
13934 BALTIMORE AVE, LAUREL, MD 20707-5000
(301) 329-5758
(410) 665-3235
Mailing address
13934 BALTIMORE AVE, LAUREL, MD 20707-5000
(301) 329-5758
(410) 665-3235
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58463100
—
MD
Enumeration date
07/05/2019
Last updated
07/05/2019
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