Organization
EPP MARYLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BERTOLLINI (CREDENTIALING MANAGER)
(315) 450-0763
Entity
Organization
Contact information
Practice address
804 PERSHING DR STE 102, SILVER SPRING, MD 20910-4436
(240) 696-7208
Mailing address
PO BOX 1584, BRENTWOOD, TN 37024-1584
(315) 450-0763
(615) 422-6719
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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