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Organization

DRKBCHASELLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KENNETH BERNARD CHASE D.D.S. (OWNER)
(301) 475-5926
Entity
Organization

Contact information

Practice address
23808 HOLLYWOOD RD, LEONARDTOWN, MD 20650-5825
(301) 475-5926
(301) 475-2653
Mailing address
23808 HOLLYWOOD RD, LEONARDTOWN, MD 20650-5825
(301) 475-5926
(301) 475-2653

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6787
MD
1223P0221X
Pediatric Dentistry
14062
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
122300000X
MD
Enumeration date
03/24/2010
Last updated
03/24/2010
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