Organization
CROWN & GLORY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NAKIA S. BUSH DDS (DENTIST/OWNER)
(240) 754-7425
Entity
Organization
Contact information
Practice address
11479 BERRY RD, WALDORF, MD 20603-5957
(202) 425-9618
(240) 754-7425
Mailing address
11479 BERRY RD, WALDORF, MD 20603-5957
(202) 425-9618
(240) 754-7425
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039376200
—
MD
Enumeration date
01/05/2021
Last updated
01/05/2021
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