Organization
SPECIALIST IN ORTHODONTICS OF MARYLAND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JO ANN RICE (CREDENTIALING MANAGER)
(470) 881-8679
Entity
Organization
Contact information
Practice address
9812 FALLS ROAD, POTOMAC, MD 20854
(770) 692-1000
Mailing address
2970 BRANDYWINE RD STE 200, ATLANTA, GA 30341
(770) 692-1000
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
14922
MD
Other
Enumeration date
04/27/2015
Last updated
12/03/2021
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