Organization
EVOLUTION ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES RYAN DDS (ORAL SURGEON/OWNER)
(301) 916-6000
Entity
Organization
Contact information
Practice address
19851 OBSERVATION DR STE 320, GERMANTOWN, MD 20876-4143
(301) 916-6000
(301) 916-6113
Mailing address
19851 OBSERVATION DR STE 320, GERMANTOWN, MD 20876-4143
(301) 916-6000
(301) 916-6113
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356508493
—
MD
Enumeration date
12/02/2020
Last updated
12/07/2020
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