Organization
POTOMAC ORAL & MAXILLOFACIAL SURGERY
Active
Parent organization
POTOMAC ORAL & MAXILLOFACIAL SURGERY
Organization subpart
Yes
Provider details
NPI number
Legal business name
POTOMAC ORAL & MAXILLOFACIAL SURGERY
Authorized official
WENDELL GARDNER DDS (OWNER)
(410) 257-5333
Entity
Organization
Contact information
Practice address
955 NORTH PRINCE FREDERICK BLVD, SUITE 104, PRINCE FREDERICK, MD 20678-3057
(410) 535-2416
(443) 968-8646
Mailing address
3150 W WARD RD, SUITE 306, DUNKIRK, MD 20754
(410) 257-5333
(410) 257-2842
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215149900
—
MD
Enumeration date
03/19/2024
Last updated
03/19/2024
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