Organization
MARLBOROUGH VILLAGE PEDIATRIC DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADRIAN JOHNSTON WILSON DDS (OWNER/DENTIST)
(443) 280-0968
Entity
Organization
Contact information
Practice address
5098 BROWN STATION RD STE 260, UPPER MARLBORO, MD 20772-9124
(240) 326-3738
Mailing address
14300 RIDGE VIEW LN, LAUREL, MD 20707-6278
(443) 280-0968
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
14704
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71150100
—
MD
Enumeration date
07/02/2018
Last updated
07/02/2018
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