Individual
PETER M TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MSHS
Contact information
Practice address
68 THOMAS JOHNSON DR, SUITE A, FREDERICK, MD 21702
(301) 694-2300
(301) 694-7372
Mailing address
68 THOMAS JOHNSON DR, SUITE A, FREDERICK, MD 21702
(301) 694-2300
(301) 694-7372
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
08276
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37385
DENTAL BENEFIT PROVIDERS
—
01
—
410662
MAMSI
—
01
—
60443
TRICARE PRIME
—
01
—
952901
UCCI
—
01
—
DE94
BCBS DENTAL
—
Enumeration date
02/03/2006
Last updated
06/21/2010
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